Direct-Acting Antivirals Offer Promising Approach to Treat Hepatitis C Among Older Adults
Fri, December 3, 2021

Direct-Acting Antivirals Offer Promising Approach to Treat Hepatitis C Among Older Adults

Researchers found that the age of the patient with hepatitis C did not appear to impact the effectiveness of the medications direct-acting antivirals. / Photo by: Jarun Ontakrai via 123rf


Interferon-free direct-acting antivirals are medications used for patients with hepatitis C, offering a cure rate of over 90 percent in real life and clinical trials. Yet, their effects and safety have not been extensively studied for older adults. A group of researchers from China and New York found that the age of the patient diagnosed with hepatitis C did not appear to impact the effectiveness of the medications direct-acting antivirals. 

Effectiveness of Interferon-Free Direct-Acting Antivirals

In their study, which was published in the Journal of the American Geriatrics Society, Calvin Q. Pan from Capital Medical University in China and their team studied 1,151 people with hepatitis C. Among the eligible patients, 516 of them were in the older group while the 635 were in the younger group. They observed that older patients had more severe liver disease and also suffer from other conditions, such as chronic kidney disease, high cholesterol, high blood pressure, and diabetes.

Despite their other existing disease aside from hepatitis C, they still had high cure rates using interferon-free direct-acting antivirals. The researchers noted that the effectiveness of the medications is similar to both younger and older patients. They, however, highlighted the importance of treating hepatitis C as early as possible for older people because it can cause liver damage.

Viral Hepatitis

Viral hepatitis is an infection that causes liver damage and inflammation. In most cases, three viruses are responsible for such infection: hepatitis A, B, and C. Hepatitis A is usually a short-term infection and is often caused by consuming contaminated water or food. Hepatitis B and C, on the other hand, are both viral infections that attack the liver and have the same symptoms. Transmission of hepatitis B and C occurs when a person comes in contact with infected blood or other bodily fluids.

The severity of the diseases ranges from mild that lasts for a few weeks to serious as a lifelong illness. The World Health Organization (WHO) published on its platform that approximately 399,000 people died from hepatitis C in 2016. Most of these recorded deaths are from hepatocellular carcinoma or HCC (primary liver cancer) and cirrhosis, which is the late-stage scarring of the liver.

WHO emphasized that antiviral medicines can cure over 95 percent of people with hepatitis C infection, reducing the risk of death from liver cancer and cirrhosis. Yet, access to treatment and diagnosis remains low. Hepatitis C is also difficult to treat for elderly patients, who have lived with the disease for a long period. In a 2015 study titled Antiviral Therapy in Elderly Patients With Hepatitis C Virus Infection, authors Justin Rheem, MD from  Harbor-University of California and colleagues said that the “rates of hepatitis C virus (HCV) infection are disproportionately higher in older patients.” This is why Pan and the team, in their recent study, wanted to find out if treatment for younger people can also be used for older adults.


Viral hepatitis is an infection that causes liver damage and inflammation. / Photo by: Kateryna Kon via 123rf


The Sustained Virologic Response Rates (SVRs) in Elderly Patients

They found out that interferon-free direct-acting antivirals offer a promising solution to patients diagnosed with hepatitis C. The sustained virologic response rates (SVRs) were similar between their two groups with overall treatment response of 97.7 percent. “Treatment should not be withheld in older individuals,” they concluded.

While advanced age has been considered a predictor of nonresponse to the antivirals, their study shows that the elderly’s SVR still has a more than 90 percent cure rate. They shared that the patients in their study were from 13 different states in the US. The team collected the data from their subjects from pre-treatment to 24 weeks posttreatment and at weeks 4, 8, 12, 16, 20, 24, 36, and 48. Other important data they included for the research were the patients’ disease history, physical findings, HCV treatment regimens, liver imaging results, and laboratory tests.

The team likewise discussed that although patients who are 65 years old and above took more drugs than patients younger than 65, the safety and efficacy of the direct-acting antivirals (DAAs) were not affected.

Hepatitis Death Rate

Our World in Data, a platform that provides data and research on global problems, has shared the death rate from hepatitis. They measured it as the number of deaths per 100,000 individuals and across all ages and both sexes.

Countries with high death rates include India (4.87), Cambodia (3.78), Niger (3.22), and Mali (3.2). Countries with low death rate include United States (0.33), Canada (0.27), Mexico (0.56), Colombia (0.13), Peru (0.27), Chile (0.18), Argentina (0.4), Brazil (0.51), Cuba (0.1), Russia (0.15), Kazakhstan (0.24), Mongolia (0.61), China (0.67), Japan (0.39), Australia (0.45), Saudia Arabia (0.45), Philippines (0.76), Thailand (0.43), South Korea (0.21), and France (0.13), among others. Meanwhile, WHO says that around 30 percent of infected people clear HCV within six months without any treatment. These are cases of acute hepatitis that do not lead to life-threatening disease.

For individuals infected with the hepatitis C virus, appropriate and early medical management is important. This includes antiviral therapy. The recent findings may prove as a holy grail not only for younger patients but the elderly too.