Treatment eligibility and outcomes in elderly patients with chronic hepatitis C: results from the VA HCV-001 Study.

OBJECTIVES

We undertook this study to determine if treatment candidacy and outcomes were similar between elderly and non-elderly patients.

METHODS

This was a prospective cohort study that screened 4,025 patients with chronic hepatitis C for HCV antiviral treatment at 24 Veterans Affairs Medical Centers throughout the country. We used multivariable logistic regression to determine whether there was an independent association between being elderly (age > 60 vs. <or= 60) and (1) being considered a treatment candidate by clinician, and (2) achieving sustained virologic response if treated.

RESULTS

364 of the 4,025 patients (9%) were over the age of 60. Only 25% of patients over the age of 60 were considered to be treatment candidates by the evaluating clinician, and only 10% were started on treatment. After adjustment for potential confounders, older age remained associated with a lower likelihood of being considered a treatment candidate (adjusted OR = 0.43; 95% CI: 0.30-0.61). Although based on a small sample of elderly treated patients (n = 35), being elderly did not appear to be associated with a lower likelihood of achieving SVR (adjusted OR = 1.54; 95% CI: 0.46-5.15).

CONCLUSION

Among veterans over the age of 60 with chronic hepatitis C who are referred for treatment, relatively few are considered treatment candidates and an even smaller number are ultimately treated. After adjusting for co-morbidities, age remains a strong predictor of not being a treatment candidate. In contrast, older age does not seem to adversely affect treatment outcomes and side effects.