Efficacy of Direct-Acting Antivirals for HCV Clearance in Older Adults

Data published in the Journal of the American Geriatrics Society suggest direct-acting antivirals (DAAs) are safe and effective at achieving a sustained virologic response in older adults with hepatitis C virus (HCV)-related fibrosis or cirrhosis.

HCV clearance is essential in improving disease outcomes in the general population, but data on reducing liver-related complications and increasing life expectancy in older adults are limited. 

A total of 253 individuals aged 80 years and older met the inclusion criteria: 40 with advanced fibrosis and 213 with liver cirrhosis. Common comorbidities were diabetes, hypertension, and history of cardiovascular disease or cerebrovascular accidents. Of these patients, 131 had 1 or 2 and 24 had 3 or more comorbidities.

Overall, 94.9% of participants achieved a sustained virologic response by week 12, and no influence of sex, age, number of comorbidities, number of coprescribed drugs, or failed previous antiviral treatment was found. During a follow-up period (mean, 14±4 months), 34 adverse events occurred in 27 patients: 10 hepatocellular carcinomas, 12 hepatic decompensations, 9 nonhepatic events, and 3 deaths. The multivariate analysis showed that risk factors for adverse events were D’Amico stages 4 and 5, with a baseline serum albumin level of 3.5 mg/dL or less and 3 or more comorbidities.

The researchers concluded that DAAs were safe and improved quality of life and positive clinical outcomes in adults at least 80 years old who have HCV and liver fibrosis or cirrhosis. The effects were especially robust for individuals with <3 comorbidities and normal albumin levels and only marginally effective for those with ≥3 comorbidities and an albumin level of 3.5 g/dL or less. Therefore, the use of DAAs is suggested for those with ≤3 comorbidities and normal serum levels and can be considered for patients in between the 2 extremes reported here. 

Reference

Ippolito AM, Iacobellis A, Milella M, et al. Hepatitis C virus clearance in older adults [published online November 14, 2017]. J Am Geriatr Soc. doi:10.1111/jgs.15140