Papić Neven, Budimir Jelena, Kurelac Ivan, Dušek Davorka, Jugović Davor, Krajcar Nina, Vince Adriana
Department for Viral Hepatitis, Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2018 Mar;57(1):61-70. doi: 10.20471/acc.2018.57.01.07.
The prevalence of chronic hepatitis C increases in elderly patients. The aims of this study were to identify the factors associated with hepatocellular carcinoma (HCC) and end-stage liver disease development and to evaluate the efficacy and safety of pegylated interferon (PEG-IFNα) plus ribavirin (RBV) therapy in elderly patients. A retrospective cohort study included all consecutive pa-tients with hepatitis C virus (HCV) infection treated with PEG-IFNα+RBV between 2003 and 2013. Elderly patients had a higher frequency of poor prognostic factors including genotype 1 infec-tion, high fibrosis, and high fibrosis index based on four factors (FIB-4) score. The sustained virologic response (SVR) rate for genotype 1 was significantly lower (35.8% vs. 57.1%), while the frequency of PEG-IFNα (27.2% vs. 7.8%), RBV dose reduction (19.6% vs. 9.7%) and treatment discontinuation (13.0% vs. 4.1%) was significantly higher in elderly patients. However, age was not associated with SVR in multivariate analysis, and comparable SVR rates were achieved when adjusted for fibrosis score (Ishak ≤3: 66.7% vs. 69.8%). During the follow-up, HCC was diagnosed in 18 elderly patients (3 SVR+, 4 SVR- and 9 untreated patients). In conclusion, selected elderly patients can achieve comparable SVR rates as younger patients, but with a higher rate of side effects. Since complications of HCV infection occur more frequently in elderly patients, they should be given priority for antiviral therapy.
老年患者中慢性丙型肝炎的患病率有所增加。本研究的目的是确定与肝细胞癌（HCC）和终末期肝病发生相关的因素，并评估聚乙二醇干扰素（PEG-IFNα）联合利巴韦林（RBV）治疗老年患者的疗效和安全性。一项回顾性队列研究纳入了2003年至2013年间所有连续接受PEG-IFNα+RBV治疗的丙型肝炎病毒（HCV）感染患者。老年患者具有更多不良预后因素，包括1型感染、高纤维化以及基于四项因素（FIB-4）评分的高纤维化指数。1型基因型的持续病毒学应答（SVR）率显著更低（35.8%对57.1%），而老年患者中PEG-IFNα的使用频率（27.2%对7.8%）、RBV剂量减少（19.6%对9.7%）和治疗中断（13.0%对4.1%）的发生率显著更高。然而，在多变量分析中年龄与SVR无关，在根据纤维化评分进行调整后（Ishak≤3：66.7%对69.8%）可达到相当的SVR率。在随访期间，18名老年患者被诊断为HCC（3名SVR阳性、4名SVR阴性和9名未接受治疗的患者）。总之，部分老年患者可取得与年轻患者相当的SVR率，但副作用发生率更高。由于HCV感染并发症在老年患者中更频繁发生，应优先给予他们抗病毒治疗。
