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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

 


  

Seniors and Hepatitis C
 
by 
V. J. Smith, RN, BSN, MA
Article Date: 1/16/2004
 
 
Hepatitis C is not just a disease of young people.  Seniors (people 
over60 years old) who are infected with Hepatitis C Virus face particular challenges, 
both in the progression of the disease and their options for treatment.
 
Clinical Studies of Hepatitis C Virus in the Elderly 
One small study found that seniors with hepatitis C infection are 
Likely to have more fibrosis than younger people infected with Hepatitis C Virus, 
and that older people tend to have higher viral loads than younger people. 
 
This study did not find a significant difference in distribution of
genotypes between older and younger populations, and found that there
was no significant difference in the efficacy rate of IFN in the 
elderly and younger groups after other variables were taken into account.1  
 
An Italian study of over 1000 senior patients found that those infected
with Hepatitis C Virus were most likely to have acquired the infection through blood
transfusion, surgical intervention and the use of non-disposable
syringes.  
  
 
Diagnostic testing of this group of Italian patients found that over 60
percent were genotype 2, and that only about a third of the group had
abnormal liver enzymes and ultrasound results, suggesting the
possibility that these elderly patients might be Hepatitis C Virus carriers.2  
 
Another review found that Hepatitis C Virus infection is generally a mild disease in
the elderly, and suggests that many older Hepatitis C Virus patients have compensated
(stable) liver disease.  
 
These authors suggest that combination of compensated disease and the
relatively low response rates to interferon mean that the drug "should
be reserved for those with the best chance of response."3
 
Researchers in Japan examined 135 patients over the age of 80 who were
diagnosed with liver disease.  The majority of study participants had
both Hepatitis C Virus infection and cirrhosis.  
 
The researchers assessed the participants for the development of liver
cancer, and found that 32 percent of those with cirrhosis had developed
liver cancer by year 7 of the study.  Their conclusion is that the
presence of cirrhosis in this elderly group was a major risk factor for
the development of liver cancer.4
 
Treatment Considerations
Treatment with alpha interferons and peginterferons, such as PEG-Intron
(Schering) and Pegasys (Roche), is associated with neuropsychiatric,
cardiac, pulmonary, gastrointestinal and systemic (flu-like) adverse
effects.   
 
These adverse reactions to interferon medications may be more severe in
the elderly, and physicians must use caution when prescribing these
medications to older people.  In general, younger patients tend to
respond better than older patients to interferon-based therapies.
 
Interferon medications are excreted by the kidneys.  Older patients are
more likely to have decreased renal function, and so the risk of toxic
reactions to this drug may be increased in this patient group.5
 
For patients with very advanced liver disease, either due to hepatitis 
C infection or liver cancer, transplantation may be necessary.  While
older age does not rule out liver transplantation, older patients have 
a significantly lower rate of survival after liver transplant.  
  
 
One study determined that cancer is a primary cause of the decreased
survival rate after transplant, and that older age and smoking were the
variables most associated with the development of post-transplant
cancer.6
 
Conclusions
People greater than 60 years old should be considered for treatment of
chronic hepatitis on an individual basis. The benefit of treatment has
not been well documented and side effects appear to be worse in older
people. 
 
Also, older people are more likely to suffer from other medical
conditions, such as heart and kidney disease, and take several 
medicines already. These factors can affect response to hepatitis 
treatment and increases the possibility of side effects.
 
Sources
1. Horiike, N. etal. Interferon therapy for patients more than 60 years
of age with chronic hepatitis C. J Gastroenterol Hepatol. 1995 May-Jun;
10(3): 246-9. 
 
2. Monica F, et al. Hepatitis C virus infection and related chronic
liver disease in a resident elderly population: the Silea Study. Eur J
Gastroenterol Hepatol. 1999 May; 11(5): 485-91.
 
3. Marcus EL, Tur-Kaspa R.  Viral hepatitis in older adults. J Am
Geriatr Soc. 1997 Jun; 45(6): 755-63.
 
4. Hoshida Y, et al. Chronic liver disease in the extremely elderly of
80 years or more: clinical characteristics, prognosis and patient
survival analysis.   J Hepatol. 1999 Nov; 31(5): 860-6.
 
5. PEG-Intron Prescribing Information. Schering Corporation.
http://www.spfiles.com/pipeg-intron.pdf
 
6. Herrero JI, et al. Liver transplant recipients older than 60 years
have lower survival and higher incidence of malignancy.  Am J
Transplant. 2003 Nov; 3(11): 1407-12.
 
V.J. Smith is a Registered Nurse with a Bachelor's degree in Nursing 
and
a Master's degree in Clinical Psychology, and has experience in
oncology, critical care and hospice, nursing management, counseling and
clinical administration.