DAA Therapy Promising for Geriatric Hepatitis C Patients

Hsu-Heng Yen

Oral antiviral therapy could increase treatment tolerability and response in geriatric patients with chronic hepatitis C virus (HCV) infections.

A team, led by Hsu-Heng Yen, Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, evaluated the efficacy and safety of direct-acting antiviral therapy for HCV in the geriatric population, a promising but understudied treatment option.

The rates of HCV infections is generally considered high in the geriatric population, largely because interferon-based therapy is usually intolerable.

Endpoints

The investigators sought primary endpoints of sustained virologic response (SVR) at the 12 week mark following treatment completion. They also sought secondary endpoints of treatment-related side effects and short-term survival rates following treatment.

There was a total of 492 patients in the study with a median age of 73 years old. The patient population included 278 early elderly patients. In addition, 45% of the patients had cirrhosis.

The most common HCV genotype was genotype 1, which was found in 72.4% of the patients, followed by genotype 2 found in 25.4% of the patients.

Results

The primary endpoint was met by 96.7% of the patients, with no differences found in sustained virologic response rates found between the early and late elderly groups (96.8% vs. 96.7%; P = 0.983).

In addition, both the late and early elderly groups showed similar side effects, including dizziness (11.4%) and fatigue (8.7%). Three patients discontinued therapy due to side effects found.

However, both age groups had a similar three-year survival rate with significant factors linked to post-treatment survival including cirrhosis, albumin, and creatinine levels.

“Our real-world data showed that both early and late elderly patients could undergo direct-acting antiviral treatment for HCV with excellent treatment outcomes,” the authors wrote.

Connection to Cataracts

A new study conducted by investigators at the Armed Forces Institute of Ophthalmology and National University of Medical Sciences, Pakistan, evaluated the prevalence of hepatitis B (HBV) and HCV among patients undergoing cataract surgery.

The study noted a greater prevalence of HCV infection. Furthermore, nuclear sclerotic cataracts had higher prevalence in infected patients—compared with noninfected patients.

In response to these gaps in understanding, the investigators assessed the link between HBV, HCV and cataract development/presentation.

Prior to patient operation, the investigators evaluated patient history regarding comorbid conditions, such as ischemic heart disease, hypertension, diabetes mellitus, and, most importantly, previous systemic infection and hepatitis, among others.

“Patients were then subjected to comprehensive ocular examination for cataract evaluation including visual acuity, anterior and posterior segment examination, intra ocular pressure measurement followed by biometry for intraocular lens (IOL) power calculation,” wrote the investigators.

The investigators also noted that “23 (65%) of patients with HBV and 80 (54.8%) of patients with HCV had nuclear sclerosis cataract as compared to 51% of non-infectious patient.”

The investigators indicated these findings affirm the importance of screening for HBV and HCV among such patients so that further transmission can prevented.

“[The infection prevalence] implies strict screening for hepatitis serology should be carried out pre-operatively in order to avoid exposure of infective agents to the operation theatre staff and surgeon,” they wrote.

The study, “Direct-acting antiviral treatment for Hepatitis C Virus in geriatric patients: a real-world retrospective comparison between early and late elderly patients,” was published online in PeerJ.