Impact of age on the characteristics and medical care of chronic hepatitis C patients treated with direct-acting antivirals

Abstract

Aim: Chronic hepatitis C is more severe in elderly patients. In France, Direct Acting Antiviral therapy must be implemented via multidisciplinary team meetings in regional reference centers. This study aimed to define the impact of age on hepatitis C characteristics and medical care types across three groups: <50, 50-70, and >70-yo. Methods: All patients with treated hepatitis C virus mono-infection during 8 to 24 weeks were included. Group comparison was based on 21 hepatitis C characteristic and medical care variables. Results: Male predominance decreased in >50-yo (59.7% vs. 72.5%, p <0.001), disappearing in >70-yo (36.2%, p <0.001). The transmission route varied depending on age, with a sharp fall in drug-use transmission in >50-yo (27.8% vs. 51.9%, p=0.02) and increase in transfusion and nosocomial infection to 30% in >70-yo. Advanced fibrosis increased in >50-yo (57.5% vs. 41.5%, p <0.001), with nearly 2/3 of >70-yo affected. Psychiatric comorbidity incidence was halved in >70-yo (7.1% vs. 14.8%, p <0.01), excessive alcohol consumption was rare (<1%), and smoking significantly dropped with age, as did cannabis consumption (p <0.001). The care structure was not age-dependent, excepting a decreased use of addictology drug prevention and care centers in ≥50-yo. Using therapeutic patient education programs decreased with age (23.8% for >70-yo vs. 43.8% for <50-yo, p <0.01), while drug interaction frequency increased, reaching nearly 25% in >70-yo. Substained virological response 12 rates did not significantly differ across the three groups. Conclusions: Age changes the characteristics and the medical care of hepatitis C, but has no impact on the cure rate.