Digestive Diseases and Sciences

, Volume 55, Issue 11, pp 3193–3199 | Cite as

Predictive Factors for Response to Peginterferon-Alpha and Ribavirin Treatment of Chronic HCV Infection in Patients Aged 65 Years and More

  • Edoardo G. Giannini
  • Monica Basso
  • Vincenzo Savarino
  • Antonino Picciotto
Original Article



Elderly patients with chronic hepatitis C virus (HCV) infection represent an understudied population, and little is known regarding the predictive factors for sustained virological response (SVR) to antiviral therapy in these patients.


To evaluate the efficacy of pegylated interferon (PEG-IFN) and ribavirin therapy in chronic HCV patients aged 65 years, and identify pre- and on-treatment predictors of SVR.


We studied 57 patients aged ≥65 years who underwent PEG-IFN and ribavirin treatment, evaluating the SVR rate and its association with pre-treatment demographic, clinical, biochemical, and virological parameters. Furthermore, we assessed whether 12-week serum HCV-RNA assessment might predict SVR.


A SVR was obtained in 25 patients (45%). The only pre-treatment predictor of SVR was HCV genotype 2 and 3 (P = 0.02). A positive serum HCV-RNA or a decline in viral load ≤2log10 at week 12 had 100% negative predictive value for SVR. No major liver-related events or deaths occurred during therapy. Treatment was discontinued due to side effects—mainly cardiovascular—in 10 patients (17%).


Pre- and on-treatment virological parameters can be used to identify elderly patients who are more likely to obtain a SVR to standard-of-care antiviral therapy for chronic HCV infection.


Elderly Hepatitis C virus Pegylated interferon Ribavirin Sustained virological response 


Conflict of interest


Financial support



  1. 1.
    Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterol. 2007;13:2436–2441.PubMedGoogle Scholar
  2. 2.
    Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol. 2008;48:148–162.CrossRefPubMedGoogle Scholar
  3. 3.
    Armstrong GL, Wasley A, Simard EP, McQuillan GM, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.PubMedGoogle Scholar
  4. 4.
    Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9:331–338.CrossRefPubMedGoogle Scholar
  5. 5.
    Mazzeo C, Azzaroli F, Giovanelli S, Dormi A, et al. Ten year incidence of HCV infection in northern Italy and frequency of spontaneous viral clearance. Gut. 2003;52:1030–1034.CrossRefPubMedGoogle Scholar
  6. 6.
    Thabut D, Le Calvez S, Thibault V, Massard J, et al. Hepatitis C in 6,865 patients 65 years or older: a severe and neglected curable disease? Am J Gastroenterol. 2006;101:1260–1267.CrossRefPubMedGoogle Scholar
  7. 7.
    Seeff LB, Hoofnagle JH. Appendix: The National Institutes of Health Consensus Development Conference Management of Hepatitis C 2002. Clin Liver Dis. 2003;7:261–287.CrossRefPubMedGoogle Scholar
  8. 8.
    Manns MP, McHutchinson JG, Gordon SC, Rustgi VK, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001;358:958–965.CrossRefPubMedGoogle Scholar
  9. 9.
    Fried MW, Shiffman ML, Reddy KR, Smith C, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347:975–982.CrossRefPubMedGoogle Scholar
  10. 10.
    Floreani A, Minola E, Carderi I, Carderi I, et al. Are elderly patients poor candidates for pegylated interferon plus ribavirin in the treatment of chronic hepatitis C? J Am Geriatr Soc. 2006;54:549–550.CrossRefPubMedGoogle Scholar
  11. 11.
    Nudo CG, Wong P, Hilzenrat N, Deschênes M. Elderly patients are at greater risk of cytopenia during antiviral therapy for hepatitis C. Can J Gastroenterol. 2006;20:589–592.PubMedGoogle Scholar
  12. 12.
    Antonucci G, Longo MA, Angeletti C, Vairo F, et al. The effect of age on response to therapy with peginterferon alpha plus ribavirin in a cohort of patients with chronic HCV hepatitis including subjects older than 65 year. Am J Gastroenterol. 2007;102:1383–1391.CrossRefPubMedGoogle Scholar
  13. 13.
    Huang CF, Yang JF, Dai CY, Huang JF, et al. Efficacy and safety of pegylated interferon combined with ribavirin for the treatment of older patients with chronic hepatitis C. J Infect Dis. 2010;201:705–709.CrossRefGoogle Scholar
  14. 14.
    Chevaliez S, Pawlotsky JM. Practical use of hepatitis C virus kinetics monitoring in the treament of chronic hepatitis C. J Viral Hepat. 2007;14(Suppl. 1):77–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Ishak K, Baptista A, Bianchi L, Callea F, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696–699.CrossRefPubMedGoogle Scholar
  16. 16.
    Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR cooperative study group. Hepatology. 1996;24:289–293.CrossRefPubMedGoogle Scholar
  17. 17.
    Davis GL. Monitoring of viral levels during therapy of hepatitis C. Hepatology. 2002;36(Suppl 1):S145–S151.CrossRefPubMedGoogle Scholar
  18. 18.
    Tong MJ, el-Farra NS, Reikes AR, Co RL. Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med. 1995;332:1463–1466.CrossRefPubMedGoogle Scholar
  19. 19.
    Monica F, Lirussi F, Nassuato G, Castelletto MR, et al. Hepatitis C virus infection and related chronic liver disease in a resident elderly population: the Silea study. J Viral Hepat. 1998;5:345–351.CrossRefPubMedGoogle Scholar
  20. 20.
    Sawabe M, Arai T, Esaki Y, Fukazawa T, et al. Persistent infection of hepatitis C virus in the elderly: a clinical an quantitative pathological study of autopsy cases. Liver. 1999;19:335–342.CrossRefPubMedGoogle Scholar
  21. 21.
    Honda T, Katano Y, Shimizu J, Ishizu Y, et al. Efficacy of peginterferon-α-2b plus ribavirin in patients aged 65 years and older with chronic hepatitis C. Liver Int. 2010;30:527–537.CrossRefPubMedGoogle Scholar
  22. 22.
    Giannini E, Botta F, Caglieris S, Fasoli A, et al. Chronic liver disease related to hepatitis C virus: age of patients seems to be the main determinant of severity independently of viral genotype”. Eur J Gastroenterol Hepatol. 1999;11:553–558.CrossRefPubMedGoogle Scholar
  23. 23.
    Floreani A. Hepatitis C: should antiviral therapy be offered to elderly patients? Nat Rev Gastroenterol Hepatol. 2009;6:503–504.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Edoardo G. Giannini
    • 1
  • Monica Basso
    • 2
  • Vincenzo Savarino
    • 1
  • Antonino Picciotto
    • 2
  1. 1.Gastroenterology Unit, Department of Internal MedicineUniversity of GenoaGenoaItaly
  2. 2.Viral Hepatitis Unit, Department of Internal MedicineUniversity of GenoaGenoaItaly

Personalised recommendations