Response of Elderly Patients to Directly Acting Anti-Hepatitis C virus Treatment and Its Impact on their Quality Of Life

Abstract

Hepatitis C virus (HCV) is a major health problem worldwide. In 2015, the global prevalence of HCV infection was 1.0%, with the highest prevalence in the Eastern Mediterranean Region (2.3%). The highest prevalence of HCV infection is present in Egypt, with 92.5% of patients infected with genotype 4. Old people with chronic hepatitis C (HCV) were considered a difficult-to-treat category. Interferon-free direct-acting antivirals (DAAs) improved treatment adherence and quality of life of old patients. DAAs are approved with high sustained virologic response (SVR) rates and lower side effects. Objective: to detect prevalence of common side effects of DDAs at one month duration and compare it to their prevalence after three months of treatment among Egyptian elderly people. Methods: it is prospective cohort study included 113 elderly patient (more than 60 years old) who are confirmed to be hepatitis c positive by polymerase chain reaction testing for hepatitis c and are candidate to receive anti hepatitis C virus treatment from Virology Center of Ain Shams University Hospitals. All participants assessed before treatment, 1 month after starting treatment, and after three months of treatment to common side effects of DAAs. According to treatment protocol used in Virology Center of Ain Shams University Hospitals, there are three regimens used in treatment: 1) sofosbuvir+ daclatasvir for 12 weeks 2) sofosbuvir+ daclatasvir+ribavirin for 12 weeks. 3) sofosbuvir+ daclatasvir+ribavirin for 24 weeks. The duration of treatment protocols may be continued up to 24 weeks (6 months) (sofosbuvir+ daclatasvir+ribavirin for 24 weeks) but we followed the patients up to 12 weeks (3 months) as the other two treatment regimens end at this time. Results: the study included 113 patients, there was some missing data mainly after three months, and it showed there was overall improving in DAAs side effects after three months of treatment in comparison to the first month. Side effects after one month of treatment doesn’t affect DAAs continuity and response which was achieved in 84.8% of the patients and all side effects decreased significantly after three months. Conclusion: DAAs therapy has been developed and has been found to be a well-tolerated therapy, safe and low adverse side effects among elderly people.