Real-world results of direct-acting antivirals use for the treatment of chronic hepatitis C in old patients

  • Mohamed El Kassas
  • Reem El Sheemy
  • Mohamed Alboraie
  • Mohamed El Badry
  • Mohamed Naguib Wifi
  • Naglaa Youssef
  • Sameera Ezzat
  • Marwa Tahoon
  • Lobna Abdelsalam
  • Sara M. AbdelhakamEmail author
  • Zainab Ali-Eldin
Research Paper

Key Summary Points


What are the real-world efficacy and safety of direct-acting antivirals (DAAs) in old chronic HCV population?


The overall sustained virological response rate was 98.9%. Higher albumin, higher platelet count, lower bilirubin and lower stage of fibrosis were among predictors of favorable response.


Different DAAs regimens were safe and effective in old patients with chronic HCV.


Background and aim

Old people with chronic hepatitis C (HCV) were considered a difficult-to-treat category with more frequent adverse events until recently. Interferon-free direct-acting antivirals (DAAs) improved treatment adherence and quality of life of old patients. In this study, we aimed at reporting the real-world efficacy and safety of DAAs, in addition to predictors of sustained virological response (SVR) in old chronic HCV population.


This is a prospective observational intention-to-treat analysis that included old chronic hepatitis C genotype-4 patients (> 65 years) treated in a single specialized viral hepatitis treatment center in Egypt. Treatment regimens were allocated according to national guidelines for treatment of hepatitis C. Primary outcome was undetectable HCV-RNA at 12-week post-treatment by PCR. Secondary outcomes were identification of predictors of SVR and assessment of safety related issues.


Our study included 864 patients (64% females) with mean age of 67.7 ± 2.8 years. Overall SVR rate was 98.9% while SVR rates for sofosbuvir/daclatasvir/ribavirin, paritaprevir/ombitasvir/ritonavir/ribavirin, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir/ribavirin, sofosbuvir/simeprevir/daclatasvir/ribavirin, sofosbuvir/simeprevir, interferon/sofosbuvir/ribavirin and sofosbuvir/ribavirin were 100%, 100%, 100%, 100%, 100%, 99.3%, 98% and 94.2%, respectively. DAAs were well tolerated. None of the patients discontinued the treatment due to adverse effects. Higher albumin, higher platelet count, lower bilirubin and lower stage of fibrosis were among predictors of favourable response.


Different DAAs regimens were safe and effective in old Egyptian patients with chronic HCV.


Direct-acting antivirals HCV Egypt Old 







Direct-acting antivirals




Hepatocellular carcinoma


Hepatitis C virus




New Cairo Viral Hepatitis Treatment Center






Pegylated interferon


Quality of life










Sustained virological response


Author contributions

Guarantor of the article: ME. Specific author contributions: ME, ZA, RE, MA, ME and SMA SM designed the research; ME, ZA, MNW, NY and SE performed the research; MT, LA and SMA contributed analytic tools; ME, ZA, MT and SMA analyzed the data; ME, ZA and SMA wrote the paper. All authors approved the final version of the manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interests or financial disclosures related to this work.

Ethical approval

This research is approved by the Institutional Review Board for Human Subject Research at National Hepatology and Tropical Medicine Research Institute (Serial: 28-2015).

Informed consent

A written informed consent was obtained from all enrolled participants before enrolment to the study.


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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  • Mohamed El Kassas
    • 1
  • Reem El Sheemy
    • 2
  • Mohamed Alboraie
    • 3
  • Mohamed El Badry
    • 4
  • Mohamed Naguib Wifi
    • 5
  • Naglaa Youssef
    • 6
  • Sameera Ezzat
    • 7
  • Marwa Tahoon
    • 7
  • Lobna Abdelsalam
    • 8
  • Sara M. Abdelhakam
    • 9
    Email author
  • Zainab Ali-Eldin
    • 10
  1. 1.Endemic Medicine Department, Faculty of MedicineHelwan UniversityCairoEgypt
  2. 2.Tropical Medicine Department, Faculty of MedicineMinia UniversityMiniaEgypt
  3. 3.Internal Medicine DepartmentAl-Azhar UniversityCairoEgypt
  4. 4.Tropical Medicine and Gastroenterology Department, Faculty of MedicineAswan UniversityAswanEgypt
  5. 5.Internal Medicine Department, Faculty of MedicineCairo UniversityCairoEgypt
  6. 6.Medical-Surgical Nursing Department, Faculty of NursingCairo UniversityCairoEgypt
  7. 7.Epidemiology and Preventive Medicine Department, National Liver InstituteMenoufia UniversityShebin El KomEgypt
  8. 8.Genome Unit, Faculty of MedicineCairo UniversityCairoEgypt
  9. 9.Department of Tropical Medicine, Faculty of MedicineAin Shams UniversityCairoEgypt
  10. 10.Internal Medicine Department, Faculty of MedicineAin Shams UniversityCairoEgypt

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