Takaki Shintaro, Ohya Kazuki, Mori Nami, Ochi Hidenori, Tsuji Keiji
Department of General Internal Medicine, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospita, Hiroshima, Japan.
Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan.
J Viral Hepat. 2025 Jul;32(7):e70048. doi: 10.1111/jvh.70048.
Recently, the incidence of hepatitis C virus (HCV) in older individuals has increased. Although direct-acting antivirals (DAAs) are widely used to treat HCV without side effects in older patients, their indications are uncertain. This study compared the survival outcomes of older patients with HCV who received DAAs and age-matched peers without HCV infection. We enrolled 218 patients with HCV aged over 75 years treated with DAA (DAA group) and 519 HCV antibody-negative individuals (control group) who underwent physical examination and follow-up at our institute between January 2015 and December 2023. The cumulative survival rate after initial examination, cause of death, and hepatocellular carcinoma (HCC) occurrence were compared between DAA-treated patients with or without a prior HCC history and the control group. All patients treated with DAAs achieved a sustained virologic response. The prognosis of the overall DAA cohort was worse compared to the control group (p < 0.001); no significant difference emerged upon limiting the comparison to the subgroup without a prior HCC history (p = 0.280), while the prognosis was significantly worse in the DAA subgroup with a prior HCC history. Propensity-score matched analysis revealed similar results (p = 0.191). The causes of death did not differ between the DAA subgroup without prior HCC and the control group. DAA eliminates HCV in patients aged over 75 years, and offers a prognosis equivalent to that of HCV-negative healthy individuals of the same age, especially in patients without a prior HCC history.
近年来，老年个体丙型肝炎病毒（HCV）的发病率有所上升。尽管直接抗病毒药物（DAAs）被广泛用于治疗老年患者的HCV且无副作用，但其适应证尚不确定。本研究比较了接受DAAs治疗的老年HCV患者与年龄匹配的未感染HCV同龄人之间的生存结局。我们纳入了2015年1月至2023年12月期间在我院接受体检和随访的218例年龄超过75岁接受DAA治疗的HCV患者（DAA组）和519例HCV抗体阴性个体（对照组）。比较了有或无既往HCC病史的接受DAA治疗的患者与对照组初次检查后的累积生存率、死亡原因和肝细胞癌（HCC）的发生情况。所有接受DAAs治疗的患者均实现了持续病毒学应答。与对照组相比，整个DAA队列的预后较差（p＜0.001）；在将比较限制于无既往HCC病史的亚组时未出现显著差异（p = 0.280），而有既往HCC病史的DAA亚组的预后显著较差。倾向评分匹配分析显示了相似的结果（p = 0.191）。无既往HCC的DAA亚组与对照组之间的死亡原因无差异。DAA可清除75岁以上患者的HCV，其预后与同龄HCV阴性健康个体相当，尤其是在无既往HCC病史的患者中。
