FEATURES OF CLINICAL COURSE AND THERAPEUTIC TACTICS IN ELDERLY PATIENTS WITH CHRONIC HEPATITIS C


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Abstract

In everyday clinical practice, elderly patients with chronic hepatitis C (CHC) are very rarely considered as candidates for antiviral treatment. Such therapeutic tactics is not always justified. The present article discusses the features of the course of CHC in the elderly patients, the efficacy and safety of antiviral therapy (AVT) in patients of this age group. It is noted that in persons aged 65 years and older HCV infection is more severe than in younger patients, with more rapid progression of fibrosis and low levels of ALT. As a consequence, cirrhosis occurs more frequently in elderly patients than in younger. There is evidence that old age is an independent risk factor for the formation of hepatocellular carcinoma. The issue of advisability of AVT in elderly patients needs to be addressed individually; the use of methods alternative to liver biopsy for definition of stage of disease and degree of fibrosis is preferable. One of the main problems of AVT is the development of ribavirin-induced anemia, which is especially dangerous in persons with cardiovascular diseases. It is emphasized that old age is not an absolute contraindication for the AVT for CHC, but possible benefits/harm ratio should be clearly determined in such patients.

References

  1. Ивашкин В.Т. Болезни печени и желчевыводящих путей. Руководство для врачей - 2-е изд. М., 2005. C 230.
  2. Ивашкин В.Т., Морозова М.А., Маевская М.В., Соколина И.А., Герман Е.Н., Бундина М.В. Факторы риска развития гепатоцеллюлярной карциномы // Российский журнал гастроэнтерологии, гепатологии и колопроктологии. 2009. № 1. С. 4-16.
  3. Ben Yehuda A, Globerson A, Krichevsky S, et al. Ageing and mismatch repair system. Mech Ageing Dev 2000;121:173-9.
  4. Cainelli F. Hepatitis C Virus Infection in the Elderly Epidemiology, Natural History and Management. Drugs Aging 2008;25(1):9-18.
  5. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005;128:343-50.
  6. Degos F, Christidis C, Ganne-Carrie N, et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut 2000;47:131-36.
  7. Foster G, et al. AASLD; October 24-28, 2003. Boston, MA. Abstract 189.
  8. Gish RG, Arora S, Nelson D, et al. End-of-treatment (EOT) response in therapy-naive patients treated for chronic hepatitis C with viramidine in combination with pegylated interferon alfa 2a. Hepatology 2004;40:388A.
  9. Horikawa N, Yamazaki T, Izumi N, et al. Incidence and clinical course of major depression in patients with chronic hepatitis type C undergoing interferon-alfa therapy: a prospective study. Gen Hosp Psychiatry 2003;25:34-8.
  10. Imai Y, Kasahara A, Tanaka H, et al. Interferon therapy for aged patients with chronic hepatitis C: improved survival in patients exhibiting a biochemical response. J Gastroenterol 2004;39:1069-77.
  11. Iwasaki Y, Ikeda H, Araki Y, et al. Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C. Hepatology 2006;43:54-63.
  12. Krawitt EL, Ashikaga T, Gordon SR, Ferrentino N, Ray MA, Lidofsky SD. Peginterferon alfa-2b and ribavirin for treatment-refractory chronic hepatitis C. J Hepatol 2005;43:243-249.
  13. McBride BF, White CM. Anemia management in heart failure: a thick review of thin data. Pharmacotherapy 2004;24(6):757-67.
  14. McHutchison J, Manns M, Lon-go D. Definition and management of anemia in patients infected with hepatitis C virus. Liver Int 2006;26:389-98.
  15. Minola E, Prati D, Suter F, et al. Age of infection affects the long-term outcome of transfusion-associated chronic hepatitis C. Blood 2002;99:4588-91.
  16. Nomura H, Tanimoto H, Kajiwara E, et al. Factors contributing to ribavirin-induced anemia. J Gastroenterol Hepatol 2004;19:1312-17.
  17. Nudo CG, Wong P, Hilzenrat N, et al. Elderly patients are at greater risk of cytopenia during antiviral therapy for hepatitis C. Can J Gastroenterol 2006;20:589-92.
  18. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997;349:825-32.
  19. Poynard T, McHutchison J, Manns M, et al. Biochemical surrogate markers of liver fibrosis and activity in a randomized trial of peginterferon alfa-2b and ribavirin. Hepatology 2003;38:481-92.
  20. Poynard T, Ratziu V, Charlotte F, et al. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C infection and alanine aminotransferase levels in the general. J Hepatol 2001;34:730-9.
  21. Rivkin A, Chawla S. Epoetin alfa for the Treatment of Combination Therapy-Induced Hemolytic Anemia in Patients Infected With Hepatitis C Virus. Pharmacotherapy 2005;25(6):862-75.
  22. Roche. Copegus medication guide. Nutley (NJ): Roche, 2007.
  23. Salkowski MS, Wasserman R, Brooks L, et al. Changes in hemoglobin during interferon alfa-2b plus ribavirin combination therapy for chronic hepatitis C viral infection. Hepatology 2004;11:243-50.
  24. Schering Plough. Rebetol product information. Kenilworth. Schering Plough, 2007.
  25. Shiffman ML, Di Bisceglie AM, Lindsay KL, et al. Peginterferon alfa-2a and ribavirin in patients with chronic hepatitis C who have failed prior therapy. Gastroenterology 2004;126:1015-23.
  26. Shiratori Y, Ito Y, Yokosuka O, et al. Antiviral therapy for cirrhotic hepatitis C: association with reduced hepatocellular carcinoma development and improved survival. Ann Intern Med 2005;142:105-14.
  27. Strader DB, Wright T, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: American Association for the Study of Liver Diseases. Hepatology 2004;39:1147-71.
  28. Takaki S, Tsubota A, Hosaka T, et al. Factors contributing to ribavirin dose reduction due to anemia during interferon alfa 2b. J Gastroenterol 2004;39:668-73.
  29. Thabut D, Le Calvez S, Thibault V, et al. Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease? Am J Gastroenterol 2006; 101: 1260-7
  30. Watson JP, Brind AM, Chapman CE, et al. Hepatitis C virus: epidemiology and genotypes in the north east of England. Gut 1996;38: 269-76.

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