Chronic Hepatitis C in the Elderly: A New Challenge

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.