Chronic Hepatitis C in the Elderly: A New Challenge

Special Article - Hepatitis C Virus

J Hepat Res. 2015;2(2): 1025.

Chronic Hepatitis C in the Elderly: A New Challenge

Rotily M¹* and Abergel A²

1Division of Geriatrics, General Hospital of the Region of Aix, France

2Hepatology Unit, University Hospital Estaing, France

*Corresponding author: Rotily M, Division of Geriatrics, General Hospital of the Region of Aix, 55 rue de Croze, 84120 Pertuis, France

Received: May 08, 2015; Accepted: July 29, 2015; Published: August 04, 2015


The growing proportion of patients aged above 65 years in Western countries, rising life expectancy, and the improved health status of most older people, together with the advent of new therapies in Chronic Hepatitis C (CHC) bring us to consider the issue of CHC in that population. This paper aims to review epidemiological data concerning Hepatitis C Virus (HCV) infection, to raise the issue of screening, and to discuss the potential impact of direct-acting antivirals in the elderly. In spite of the paucity of data, there is some evidence to claim that the prevalence/incidence of CHC and its complications (cirrhosis and hepatocellular carcinoma) among the elderly are equal to or even higher than in younger populations. Data on acceptance and feasibility of HCV screening are partial, but both the epidemiology of CHC and its complications, and ethical considerations should lead us to avoid exclusion of the elderly from HCV screening policy. The recent introduction of a series of direct anti-viral agents offers the potential to revolutionize treatment in terms of efficacy and safety in all groups of populations. Inclusion of patients aged above 65 both in clinical trials and cost-effectiveness/benefit analyses should be a priority in terms of public health and ethics.

Keywords: Hepatitis C; Elderly; Geriatrics; Epidemiology; Screening; Cost- Effectiveness


Since the emergence of screening tests, infection with Hepatitis C Virus (HCV) has been considered a disease of young and mature adults. However, in most Western countries the elderly population is growing dramatically, its life expectancy is increasing, and its health status is improving. People aged above 65 represented 12.4% of the US population in the year 2000 and are expected to grow to 19% of the population by 2030. Persons reaching age 65 have an average life expectancy of an additional 19.3 years (20.5 years for females and 17.9 years for males) [1]. In most European countries, the aging population is greater. The French National Institute for Statistics and Economical Studies anticipates that in 2050, one third of the inhabitants will be above 60 years, versus one in five in 2005 [2]. In 2013, the life expectancy at age 65 was 18.2 and 22.7 years in male and female respectively in France (versus 17.5 and 21.9 in 2005) [2]. This trend is unlikely to slow down or reverse in the future, and it could spread over most countries.

At the same time, many countries have implemented HCV prevention policies, especially towards drug addicts, and have reported a plateau or a reduction in HCV incidence. In France, 232,196 persons were estimated to be chronically infected with HCV in 2004. The prevalence of HCV-antibodies has decreased among people aged 20-39 years between 1994 and 2004 [3], from 1.3-1.4% down to 0.14-0.31%. Consequently, there was a shift in the mean age of people infected with HCV.

With the advent of new therapies and Direct-Acting Antivirals (DAA) for the treatment of hepatitis C virus infection [4], it follows that strategies to treat HCV infection in the elderly should be reassessed in the light of their efficacy and safety profile. Thus the issue of hepatitis C in the elderly should be clearly considered and discussed.

The aim of this paper is to state the epidemiological situation in a low HCV endemic and aging country such as France, to discuss the specificities of HCV infection screening in the elderly, and to introduce the challenges facing liver and infectious diseases experts in the new era of direct-acting antivirals.

Review of epidemiology and burden of hepatitis C in the elderly

An estimated 7.3–8.8 million people (1.1–1.3%) are infected with HCV in Europe [5]. Estimations via HCV-attributable fractions indicate that HCV caused more than 86,000 deaths and 1.2 million DALYs in the WHO European region in 2002. About one quarter of the liver transplants performed in 25 European countries in 2004 were attributable to HCV [5]. No data are available as regards the age groups above 65.

When searching published papers focused on HCV infection in the elderly, one observes first the paucity of data. A bibliographic search in Pub Med including the keywords “hepatitis C”, “epidemiology” and “elderly” (in the title) produced few papers, all of them published before 2010. The prevalence of HCV infection in the elderly varies among different studies and countries [6-15] (Table 1). In the US, the prevalence ranged between 0.9 and 1% in the age groups 60–69 and ≥ 70 in the US [7]. In Italy, among 496 elderly people with a mean age of 79 years, the prevalence of HCV-antibodies was found to be around 11% [10]. A study from Japan revealed an HCV-antibodies seropositivity of 8.8% and 13.1% in hospital and autopsy cases older than 60 years of age, respectively [15]. The identifiable potential risk factors for HCV infection in that population were a history of blood transfusion, war service, a history of contaminated syringes and needles, tattoos, hemodialysis, and being a health care worker; drug use was not included [15].

Citation: Rotily M and Abergel A. Chronic Hepatitis C in the Elderly: A New Challenge. J Hepat Res. 2015;2(2): 1025. ISSN : 2381-9057