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Hepatitis C (J Raybould, Section Editor)

Hepatitis C Virus in the Elderly in the Direct-Acting Antiviral Era: from Diagnosis to Cure Mubeen Khan Mohammed Abdul, MD1 Heather S. Snyder, PharmD, BCPS2 Mythili Chunduru, PharmD, BCPS3 Susan M.K. Lee, PharmD, BCPS, CDCES4 Sanjaya K. Satapathy, MBBS, MD, DM, MS, FACG, FASGE, AGAF, FAASLD4,5,* Address 1 Department of Hepatology, Advocate Aurora St Luke’s Medical Center, Milwaukee, WI, USA 2 Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA 3 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA *,4 Department of Internal Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Division of Hepatology, Northwell Health, 400 Community Drive, Manhasset, NY, 11030, USA Email: [email protected] 5 Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Drive, Manhasset, NY, 11030, USA

Published online: 11 August 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020

This article is part of the Topical Collection on Hepatitis C Keywords Elderly I Aging I Direct acting antivirals I Hepatitis C virus I Drug interactions

Abstract Purpose of review Hepatitis C (HCV) is the most common cause of viral hepatitis in elderly individuals. This patient population previously experienced suboptimal outcomes with interferon-based regimens. Unfortunately, patients aged 65 years and older were underrepresented in phase 2 and 3 clinical trials with newer direct acting antiviral (DAA) therapies. Since the advent of second-generation DAA in 2013, numerous robust realworld experiences highlighting the efficacy and safety of DAA in the elderly have been published. This review article summarizes the cascade of care for hepatitis C from diagnosis to cure from an evidence-based perspective of the aging population. Recent finding In a large study from the Veterans Affairs Healthcare System, the overall sustained virologic response (SVR) of 15,884 patients treated with DAA regimens was 91.2%. These newer therapies remained highly effective in the subset of patients aged

HCV in the Elderly in the Direct-Acting Antiviral Era

Abdul et al. 297

65 years and older with SVR rates above 90%. A Spanish National Registry reported outcomes in patients ≥ 65 years old treated for HCV with oral DAA regimens over a 2year period. The overall SVR was 94% in the study of 1252 subjects. Summary Current real-world data imply DAA treatment regimens remain highly effective and safe in elderly patients when compared to the general population.

Introduction Chronic hepatitis C affects 71 million people worldwide according to the World Health Organization (WHO) estimates [1]. WHO aims to decrease the incidence of hepatitis C by 80% and mortality by 65% globally by the year 2030. In the United States, chronic hepatitis C virus (HCV) has the highest mortality attributed to any infectious disease [2]. In 2012, the Centers for Disease Control and Prevention (CDC) added recommendations for one-time HCV scr