Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7412
Peer-review started: January 14, 2015
First decision: March 26, 2015
Revised: April 10, 2015
Accepted: May 20, 2015
Article in press: May 21, 2015
Published online: June 28, 2015
Due to the progressive aging of the hepatitis C virus (HCV) population which have acquired 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-related liver 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-known contraindications and side effects of interferon (IFN). The arrival of several new anti-HCV drugs, and the possibility to combine them in safe and effective anti-viral regimens, is relighting the hope of a cure for many elderly patients who had been cut out of IFN-based treatments. However, although these new regimens will be certainly more manageable, it should be underscored that IFN-free doesn’t mean free from any contraindication or side-effect. Moreover, one issue which promises to become central is that of the possible interactions between antiviral therapy and the multiple drugs frequently assumed by elderly patients because of comorbidities. In this review, we will revise the epidemiology pointing to HCV as an infection of the elderly, the evidences that HCV harms the health of the aged patient more than that of the young one, and the available experiences of HCV treatment in the elderly with the “old” IFN-based regimens and with the newer drugs. We will conclude that the availability of IFN-free regimens should prompt us to change our mind and consider a significantly larger number of possible candidates among elderly patients, who would take significant advantage from viral eradication. Rather than the anagraphic age, drug-drug interactions and, mainly in case of economic restrictions, an evaluation of life expectancy dependent on liver disease with respect to that dependent on comorbidities, are likely to be the key issues guiding treatment indication in the next future. The sooner we will change our mind 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.
Core tip: Hepatitis C virus (HCV) infection is a significant threat to the health of elderly patients, in whom liver disease progresses very rapidly and extrahepatic complications affect the quality of life. Till now, treatment attempts have been substantially limited by the side effects of interferon (IFN). Here we discuss how the availability of IFN-free regimens should prompt us to change our mind when assessing treatment indication and to consider a significantly larger number of possible candidates among elderly patients. Drug-drug interactions and assessment of liver disease-dependent vs comorbidities-dependent life expectancy, rather than anagraphic age, are likely to guide the choice of the aged HCV patients to be treated in the next future.