Due to the progressive aging of the hepatitis C virus (HCV) population which haveacquired the infection during its maximum spread after the Second World War, the management of the elderly HCV-infected patient is emerging as a hot topic.Unfortunately, although it is recognized that the progression of HCV-relatedliver disease gets faster with aging, and that even extra-hepatic manifestations of HCV infection are probably worse in the elderly, till now, treatment attempts in this population have been significantly limited by the well-knowncontraindications and side effects of interferon (IFN). The arrival of severalnew anti-HCV drugs, and the possibility to combine them in safe and effectiveanti-viral regimens, is relighting the hope of a cure for many elderly patientswho had been cut out of IFN-based treatments. However, although these newregimens will be certainly more manageable, it should be underscored thatIFN-free doesn't mean free from any contraindication or side-effect. Moreover,one issue which promises to become central is that of the possible interactionsbetween antiviral therapy and the multiple drugs frequently assumed by elderlypatients because of comorbidities. In this review, we will revise theepidemiology pointing to HCV as an infection of the elderly, the evidences thatHCV harms the health of the aged patient more than that of the young one, and theavailable experiences of HCV treatment in the elderly with the "old" IFN-basedregimens and with the newer drugs. We will conclude that the availability ofIFN-free regimens should prompt us to change our mind and consider asignificantly larger number of possible candidates among elderly patients, whowould take significant advantage from viral eradication. Rather than theanagraphic age, drug-drug interactions and, mainly in case of economicrestrictions, an evaluation of life expectancy dependent on liver disease withrespect to that dependent on comorbidities, are likely to be the key issuesguiding treatment indication in the next future. The sooner we will change ourmind with respect to an a priori obstacle for anti-HCV treatment in the elderly, the sooner we will begin to spare many aged HCV patients from avoidable liver-related complications.

Hepatitis C treatment in the elderly: New possibilities and controversies towards interferon-free regimens

Vespasiani Gentilucci U;Galati G;Gallo P;De Vincentis A;Riva E;Picardi A
2015-01-01

Abstract

Due to the progressive aging of the hepatitis C virus (HCV) population which haveacquired the infection during its maximum spread after the Second World War, the management of the elderly HCV-infected patient is emerging as a hot topic.Unfortunately, although it is recognized that the progression of HCV-relatedliver disease gets faster with aging, and that even extra-hepatic manifestations of HCV infection are probably worse in the elderly, till now, treatment attempts in this population have been significantly limited by the well-knowncontraindications and side effects of interferon (IFN). The arrival of severalnew anti-HCV drugs, and the possibility to combine them in safe and effectiveanti-viral regimens, is relighting the hope of a cure for many elderly patientswho had been cut out of IFN-based treatments. However, although these newregimens will be certainly more manageable, it should be underscored thatIFN-free doesn't mean free from any contraindication or side-effect. Moreover,one issue which promises to become central is that of the possible interactionsbetween antiviral therapy and the multiple drugs frequently assumed by elderlypatients because of comorbidities. In this review, we will revise theepidemiology pointing to HCV as an infection of the elderly, the evidences thatHCV harms the health of the aged patient more than that of the young one, and theavailable experiences of HCV treatment in the elderly with the "old" IFN-basedregimens and with the newer drugs. We will conclude that the availability ofIFN-free regimens should prompt us to change our mind and consider asignificantly larger number of possible candidates among elderly patients, whowould take significant advantage from viral eradication. Rather than theanagraphic age, drug-drug interactions and, mainly in case of economicrestrictions, an evaluation of life expectancy dependent on liver disease withrespect to that dependent on comorbidities, are likely to be the key issuesguiding treatment indication in the next future. The sooner we will change ourmind with respect to an a priori obstacle for anti-HCV treatment in the elderly, the sooner we will begin to spare many aged HCV patients from avoidable liver-related complications.
2015
HCV; Antiviral treatment; elderly
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/2092
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