Hepatitis C Patients Over the Age of 75 Should Be Treated With Direct-Acting Antivirals, as Their Prognosis With Treatment Is Similar to That of Uninfected Healthy Individuals of the Same Age.

Recently, the incidence of hepatitis C virus (HCV) in older individuals has increased. Although direct-acting antivirals (DAAs) are widely used to treat HCV without side effects in older patients, their indications are uncertain. This study compared the survival outcomes of older patients with HCV who received DAAs and age-matched peers without HCV infection. We enrolled 218 patients with HCV aged over 75 years treated with DAA (DAA group) and 519 HCV antibody-negative individuals (control group) who underwent physical examination and follow-up at our institute between January 2015 and December 2023. The cumulative survival rate after initial examination, cause of death, and hepatocellular carcinoma (HCC) occurrence were compared between DAA-treated patients with or without a prior HCC history and the control group. All patients treated with DAAs achieved a sustained virologic response. The prognosis of the overall DAA cohort was worse compared to the control group (p < 0.001); no significant difference emerged upon limiting the comparison to the subgroup without a prior HCC history (p = 0.280), while the prognosis was significantly worse in the DAA subgroup with a prior HCC history. Propensity-score matched analysis revealed similar results (p = 0.191). The causes of death did not differ between the DAA subgroup without prior HCC and the control group. DAA eliminates HCV in patients aged over 75 years, and offers a prognosis equivalent to that of HCV-negative healthy individuals of the same age, especially in patients without a prior HCC history.