Occasionally I hear older adults with hepatitis C say, “I am too old for treatment.” This may have been true in the old interferon days, when treatment was fraught with side effects. It’s not true now. In honor of Older Americans Month, let’s look at the current information pertaining to treating older adults with hepatitis C.
Hepatitis C affects all age groups. The U.S. population is experiencing record numbers of aging adults living with hepatitis C. Sadly, the rate of death from hepatitis C among older adults is increasing. In 2013, hepatitis C claimed nearly twice the number of 65 to 74 year olds than had died in 2009. The death rate also rose in the 75 and over set.
Death from hepatitis C might be prevented with treatment, particularly if medications are taken before the onset of cirrhosis. In 2011, Baby Boomers began moving on to Medicare, and with that, an opportunity to screen and treat them for hepatitis C.
Regarding treatment, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) guidelines “When and In Whom to Initiate HCV Therapy” (Recommendations for Testing, Managing, and Treating Hepatitis C) state the following:
Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure, and as such, is expected to benefit nearly all chronically infected persons. Evidence clearly supports treatment in all HCV-infected persons, except those with limited life expectancy (less than 12 months) due to non–liver-related comorbid conditions.
In short, among adults, age is not a disqualifying factor. Also, the guidelines note that older age at time of infection is associated with accelerated fibrosis progression. So, if hepatitis C is acquired late in life, then hepatitis C treatment may be especially warranted.
What about current treatment? Clinical trials with Harvoni, Sovaldi, and Viekira Pak showed no differences in older subjects used in studies (65 and over). The numbers are small, but in the Forums, people seem to be doing as well as younger patients. There isn’t any data regarding older adults using Olysio and ribavirin, but common sense suggests caution when using either of these two drugs in the combinations for which they are indicated.
As we celebrate older Americans this month, let’s not forget those with hepatitis C. It’s time to cure them too. Urge those were born from 1945 through 1965 to get tested for hepatitis C. Those born before 1945 need to be tested if they have a risk factor.