AGING AND INFECTIOUS DISEASES – Chronic Hepatitis C Virus Infection in Older Adults

Clinical Infectious Diseases 2005;41:1606-1612

Kevin P. High, Section Editor

Esther-Lee Marcus1 and Ran Tur-Kaspa2,3

1Acute Geriatric Department, Herzog Hospital, The Hebrew University-Hadassah Medical School, Jerusalem, and 2Department of Medicine D and 3Liver Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Most of the older adults with chronic hepatitis C virus infection acquired the disease earlier in life. These patients often present with complications of liver disease, mainly cirrhosis and hepatocellular carcinoma. The burden of chronic hepatitis C virus infection in elderly persons is expected to increase significantly in the United States during the next 2 decades. It seems important that, for elderly patients with chronic hepatitis C, the risk-benefit of combination antiviral therapy consisting of pegylated interferon and ribavirin should be assessed on an individual basis. Assessment should be performed in all cases before considering treatment, and it should include evaluation of the degree of liver fibrosis by means of liver biopsy or, possibly, by means of noninvasive methods. Novel antiviral drugs that may have fewer adverse effects, such as protease inhibitors, may serve as potential alternatives. It is recommended that elderly patients (up to the age of 75 years) be included in randomized trials of chronic hepatitis C virus infection treatment.