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Elderly veterans with chronic HCV at increased risk for cirrhosis, HCC

Elderly veterans with hepatitis C virus infection had a higher risk for developing cirrhosis or hepatocellular carcinoma compared with younger patients, according to results from a retrospective cohort study.

“These data are relevant to the thousands of elderly patients with [chronic HCV] and to their physicians, who provide care and counseling to this population,” Fasiha Kanwal, MD, MSHS, of Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, and colleagues wrote.

Fasiha Kanwal

The researchers conducted this study of 161,744 patients with HCV enrolled in the Veterans Health Administration Hepatitis C Clinical Case Registry to determine any association between age subgroups and risk of cirrhosis, HCC or mortality. Three age subgroups comprised the cohort: 36.8% were aged between 20 and 49 years, 57.6% were between 50 to 64 years and 5.6% were between 65 and 85 years.

Results showed that the risk for cirrhosis (HR = 1.14; 95% CI, 1–1.29), HCC (HR = 2.44; 95% CI, 1.99–2.99) and mortality (HR = 2.09; 95% CI, 1.98–2.22) were all higher in elderly patients with HCV compared with younger patients.

The incidence of HCC was highest among the elderly veterans (8.4 per 1,000 person-years) compared with veterans aged between 20 and 49 years (2.6 per 1,000 person-years) and aged between 50 and 64 years (5.7 per 1,000 person-years).

The elderly veterans were least likely to receive antiviral treatment (3.8%) compared with veterans aged between 20 and 49 years (14.8%) and between 50 and 64 years (19.1%; P < .0001). However, among elderly veterans who received treatment and achieved sustained virologic response (33.5%), the rate of SVR was not significantly different from the other age groups (33.2% and 32.1%).

In an analysis limited to only veterans who received treatment, SVR compared with treatment receipt with no SVR was associated with decreased risk for developing cirrhosis (HR = 0.34; 95% CI, 0.18–0.66), HCC (HR = 0.6; 95% CI, 0.22–1.61) and all-cause mortality risk (HR = 0.52; 95% CI, 0.33–0.82).

“Our findings indicate long-term benefit to SVR among elderly patients while adjusting for other demographic and clinical factors, including comorbidities,” the researchers wrote.

The researchers concluded: “Elderly patients with [chronic HCV] are more likely to develop HCC than younger patients, but have traditionally received less antiviral treatment than younger patients … receipt of curative antiviral treatment is associated with a reduction in risk of cirrhosis, HCC or overall mortality, irrespective of age.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.