Managing Hepatitis C in Elderly Patients: Risks and Treatment Options

Q: Managing Hepatitis C in Elderly Patients: Risks and Treatment Options

Hello： 1. <br>If your grandmother does not have cirrhosis yet, and you are considering the side effects, it should be fine not to treat her. <br>Since she has likely been infected for several decades, if she is 91 years old and has not shown signs of cirrhosis, it is unlikely tha

Hepatitis C virus issues

Hello Doctor, my grandmother is currently 91 years old.
She recently had a blood test, and the results showed that she has several million copies of the hepatitis C virus.
The outpatient doctor has suggested a three-month course of medication.
Considering her advanced age and other health issues (such as having a pacemaker and a history of uterine removal leading to bladder prolapse), we are concerned about the potential side effects of the medication.
Will she be able to tolerate the side effects? If we do not treat the virus, will the viral load increase rapidly, leading to a quicker onset of liver cancer? We are weighing the risks and would appreciate your professional assessment.
Thank you.

Xiao Man, 20~29 year old female. Ask Date: 2019/02/17

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If your grandmother does not have cirrhosis yet, and you are considering the side effects, it should be fine not to treat her.
Since she has likely been infected for several decades, if she is 91 years old and has not shown signs of cirrhosis, it is unlikely that she will develop cirrhosis quickly.
2.
If there is already severe fibrosis or even cirrhosis in the liver, treatment is recommended, as it can slow down the deterioration of liver function.
3.
Generally, the new antiviral medications for hepatitis C have very mild side effects, and many patients can take them without issues.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2019/02/17

More Info

Managing Hepatitis C in elderly patients, particularly those with comorbidities, is a complex issue that requires careful consideration of both the risks associated with the disease and the potential side effects of treatment. In your grandmother's case, at 91 years old, the presence of Hepatitis C (HCV) with a viral load in the millions raises important questions about her overall health and the best course of action.

Firstly, it is essential to understand that Hepatitis C can lead to significant liver damage over time, including cirrhosis and liver cancer (hepatocellular carcinoma). However, the progression of liver disease can vary widely among individuals. Many patients can live for decades without severe liver damage, especially if they do not have other risk factors such as heavy alcohol use or additional liver diseases. Given that your grandmother has not shown signs of liver cirrhosis at her advanced age, it is possible that her liver has been able to tolerate the virus for many years.

The decision to initiate antiviral therapy, such as direct-acting antivirals (DAAs), should be made after a thorough evaluation of her liver function and overall health status. DAAs are generally well-tolerated and have fewer side effects compared to older treatments like interferon. However, elderly patients, especially those with multiple health issues, may still experience adverse effects. Common side effects can include fatigue, headache, and gastrointestinal disturbances, but serious side effects are rare. The presence of a cardiac pacemaker and her history of bladder prolapse may complicate her treatment, necessitating a careful review of her medications and health conditions.

If treatment is not initiated, there is a risk that the viral load could increase, potentially leading to liver damage over time. While it is difficult to predict how quickly this might occur, chronic Hepatitis C can indeed progress to cirrhosis and increase the risk of liver cancer. Regular monitoring of liver function tests and imaging studies can help assess her liver health over time.

In terms of management, it is crucial to have a multidisciplinary approach involving a hepatologist or a gastroenterologist who specializes in liver diseases. They can provide a comprehensive evaluation of her liver health, including non-invasive tests to assess fibrosis or cirrhosis, such as elastography or FibroScan. This information is vital in determining whether treatment is necessary and appropriate.

Additionally, lifestyle modifications can play a significant role in managing Hepatitis C. Encouraging a balanced diet, regular physical activity (as tolerated), and avoiding alcohol can help support liver health. Vaccinations for hepatitis A and B, if not already received, are also recommended to prevent further liver complications.

In conclusion, the decision to treat your grandmother's Hepatitis C should be made collaboratively with her healthcare team, weighing the potential benefits of treatment against the risks of side effects and her overall health status. Regular monitoring and supportive care can also help manage her condition effectively. It is essential to have open discussions with her doctors about her specific situation to make the most informed decision possible.

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