Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease?
BACKGROUND
Few data are available on chronic hepatitis C (CHC) in elderly patients. The aim of this study was to compare the features and severity of CHC and the efficacy/safety of antiviral therapy in patients<65, between 65 and 80, and >80 yr old, and to determine the usefulness of biochemical markers (Fibrotest-Fibrosure/ActiTest [FT-AT]) in aged patients.


METHODS
This was a retrospective study with two groups of patients: Group 1: prospective cohort including all hepatitis C virus patients from our institution (N=4,182); Group 2: all consecutive patients who had FT-AT performed in France between 2002 and 2004 (N=33,738).


RESULTS
A total of 6,865 patients>or=65 yr old was included (Group 1=881, Group 2=5,984). Group 1: patients>or=65 had a longer duration of and a higher age at infection, more genotype 1, and a history of transfusion (p<0.001). Among the 2,169 patients who underwent liver biopsy, bridging fibrosis (F2,F3,F4) was more frequent in patients>or=65 yr old, regardless of the duration of infection. In multivariate analysis, ages at biopsy and at infection were associated with F2,F3,F4. Discovery of CHC by a complication was more frequent in patients>or=65 yr (p<0.001). One hundred seventy patients>or=65 yr received antiviral therapy. A sustained virologic response was obtained in 45% of patients>or=65 yr treated with pegylated interferon/ribavirin. Group 2: At FT, 58% of patients>80 yr, 37% of patients between 65 and 80 yr, and 14% of patients<65 yr (p<0.001) had cirrhosis. Patients>80 yr (43%) with cirrhosis had nonelevated alanine amino transferase (ALT), compared with 31% of patients<65 yr (p<0.001).


CONCLUSIONS
In patients>or=65 yr, CHC is more severe and presents with lower ALT than in younger patients. Treatment is effective. Biochemical markers seem particularly useful as a noninvasive alternative to liver biopsy in this population.
Thabut
Dominique
D
Services d'Hépato-Gastroentérologie, Group Hospitalier Pitié-Salpêtrièe, Paris, France.
Le Calvez
Sophie
S
Thibault
Vincent
V
Massard
Julien
J
Munteanu
Mona
M
Di Martino
Vincent
V
Ratziu
Vlad
V
Poynard
Thierry
T
D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012720:Severity of Illness Index
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons; D000410:Alanine Transaminase