Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy.
Clinics of Infectious Diseases, University of Bari, Bari, Italy.
J Am Geriatr Soc. 2018 Jan;66(1):85-91. doi: 10.1111/jgs.15140. Epub 2017 Nov 14.
To determine whether older adults with the hepatitis C virus (HCV) achieve a sustained viral response (SVR) after treatment with direct-acting antiviral therapy.
Individuals aged 80 and older with chronic HCV infection (N = 253; n = 213 with cirrhosis, n = 40 with advanced fibrosis).
We investigated the efficacy, safety, and global clinical effect of treatment with different combinations of direct antiviral agents (DAAs). Participants with cirrhosis were staged according to Child-Pugh-Turcotte class, Model for End-Stage Liver Disease score, and the D'Amico staging system. The type and number of comorbidities at baseline and hepatic and nonhepatic events during follow-up were registered.
Ninety-five percent of participants with cirrhosis and 95% of those with advanced fibrosis attained SVR. The rate was independent of sex, HCV genotype, and treatment schedule. During a mean follow-up of 14 ± 4 months (range 5-23 months), 34 events occurred in 27 participants: 10 hepatocellular carcinomas, 12 hepatic decompensations, 9 nonhepatic events, 3 deaths. Multivariate analysis of risk factors for experiencing adverse events during follow up showed that participants in D'Amico Stages 4 and 5, with a baseline serum albumin level of 3.5 mg/dL or less, and 3 or more comorbidities were the most at risk.
In a real-world setting, DAAs are safe and effective in older adults with HCV-related advanced fibrosis or cirrhosis. Individuals with preserved albumin synthesis and fewer than 3 comorbidities at baseline have the most to gain from long-term DAA therapy.
确定接受直接作用抗病毒治疗的老年丙型肝炎病毒 (HCV) 感染者是否能获得持续病毒学应答 (SVR)。
253 名年龄 80 岁及以上的慢性 HCV 感染者（213 名有肝硬化，40 名有晚期纤维化）。
我们研究了不同直接抗病毒药物 (DAAs) 联合治疗的疗效、安全性和全球临床效果。肝硬化患者根据 Child-Pugh-Turcotte 分级、终末期肝病模型评分和 D'Amico 分期系统进行分期。记录基线时的合并症类型和数量，以及随访期间的肝性和非肝性事件。
95%的肝硬化患者和 95%的晚期纤维化患者获得了 SVR。这一比例与性别、HCV 基因型和治疗方案无关。在平均 14±4 个月（5-23 个月）的随访期间，27 名患者中有 34 人发生了 34 起事件：10 例肝细胞癌，12 例肝失代偿，9 例非肝性事件，3 例死亡。对随访期间发生不良事件的危险因素进行多变量分析显示，D'Amico 分期为 4 期和 5 期、基线时血清白蛋白水平<3.5mg/dL 且有 3 种或以上合并症的患者风险最高。
在真实世界环境中，DAAs 对有 HCV 相关晚期纤维化或肝硬化的老年患者是安全有效的。基线时白蛋白合成正常且合并症少于 3 种的患者从长期 DAA 治疗中获益最大。
