Хронический гепатит С у лиц пожилого возраста


Бурневич Э.З., Лопаткина Т.Н.

Кафедра терапии и профзаболеваний Первого МГМУ им. И.М. Сеченова, Москва
Обсуждаются эпидемиология, особенности течения и осложнений хронического гепатита С (ХГС) у лиц пожилого возраста. Представлены показания и возможные противопоказания к назначению противовирусной терапии (ПВТ) у этой категории больных. Отмечается, что у пожилых больных ХГС часто отмечаются неудовлетворительные результаты ПВТ, что может быть обусловлено сочетанием ряда неблагоприятных факторов (продвинутый фиброз печени, инфицирование 1-м генотипом HCV, высокая вирусная нагрузка, наличие стеатогепатита метаболического и алкогольного генеза, низкая приверженность ПВТ в связи с плохой переносимостью лечения и т. д.). Вопрос о целесообразности ПВТ у больного ХГС пожилого возраста с оценкой соотношения польза/риск должен быть решен в каждом наблюдении в индивидуальном порядке с учетом всех факторов (сопутствующие заболевания, активность ХГС, стадия заболевания и т. д.).

Литература


1. www.who. int/mediacent re/fact sheet s /fs164/en/


2. Monica F, Lirussi F, Nassuato G, et al. Hepatitis C virus infection and related chronic liver disease in a resident elderly population: the Silea study. J Viral Hepat 1998;5:345–51.


3. Van der Poel CL, Kuypers HT, Reesink HW. Hepatitis C virus six years on. Lancet 1994;344:1475–79.


4. Sirchia G, Almini D, Bellobuono A, et al. Prevalence of hepatitis C virus antibodies in Italian blood donors. Vox Sang 1990; 59:26–29.


5. Armstrong GL, Wasley A, Simard EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705–14.


6. Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999;341:556–62.


7. Мarcus EL, Dahoudi N, Tur-Kaspa R. Hepatitis C virus infection among elderly patients in a geriatric hospital. Arch Gerontol Geriatrics 1994;19:213–21.


8. Balogun MA, Ramsay ME, Hesketh LM, et al. The prevalence of hepatitis C in England and Wales. J Infect 2002;45:219–26.


9. Thierfelder W, Hellenbrand W, Meisel H, et al. Prevalence of markers for hepatitis A, B and C in the German population: results of the German National Health Interview and Examination Survey 1998. Eur J Epidemiol 2001; 17:429–35.


10. Sawabe M, Arai T, Esaki Y, et al. Persistent infection of hepatitis C virus in the elderly: a clinical and quantitative pathological study of autopsy cases. Liver 1999;19:335–42.


11. Okayama A, Stuver SO, Tabor E, et al. Incident hepatitis C virus infection in a communitybased population in Japan. J Viral Hepat 2002;9:43–51.


12. Mazzeo C, Azzaroli F, Giovanelli S, et al. Ten year incidence of HCV infection in northern Italy and frequency of spontaneous viral clearance. Gut, 2003;52:1030–34.


13. Baldo V, Floreani A, Menegon T, et al. Prevalence of antibodies against hepatitis C virus in the elderly: a seroepidemiological study in a nursing home and in an open population. Gerontology 2000;46:194–98.


14. Maggi G, Armitano S, Brambilla L, et al. Hepatitis C infection in an Italian population not selected for risk factors. Liver 1999;19:427–31.


15. Stroffolini T, Menchinelli M, Taliani G, et al. High prevalence of hepatitis C virus in small central Italian town: lack of evidence of parenteral exposure. Ital J Gastroenterol 1995; 27:235–38.


16. Maio G, D'Argenio P, Stroffolini T, et al. Hepatitis C virus infection and alanine aminotransferase levels in the general population: a survey in a southern Italian town. J Hepatol 2000;33:116–20.


17. Garcia-Fulgueiras A, Tormo MJ, Rodriguez T, et al. Prevalence of hepatitis B and C markers in the south-east of Spain: an unlinked community-based serosurvey of 2,203 adults. Scand. J Infect Dis 1996;28:17–20.


18. Dubois F, Desenclos JC, Mariotte N, et al. Hepatitis C in a French population based survey, 1994: seroprevalence, frequency of viremia, genotype distribution, and risk factors. Hepatology 1997;25:1490–96.


19. Brind AM, Watson JP, James OF, et al. Hepatitis C virus infection in the elderly. Q J M 1996;89:291–96.


20. Armstrong GL, Alter MJ, McQuillan GM, et al. The past incidence of hepatitis C infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000;31:777–82.


21. Berenguer M. Treatment of chronic hepatitis C in hemodialysis patients. Hepatology 2008;48:1690–99.


22. Masuko K, Mitsui T, Iwano K, et al. Infection with hepatitis GB virus C in patients on hemodialysis. N Engl J Med 1996;334:1485–90.


23. Saxena AK, Panhotra BR. The vulnerability of middle-aged and elderly patients to hepatitis C Virus infection in a high-prevalence hospitalbased hemodialysis setting. J Am Geriatr Soc 2004;52:242–46.


24. Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002;6(1):35–46.


25. Thabut D, Le Calvez S, Thibault V, et al. Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease? Am J Gastroenterol 2006;101:1260–67.


26. Minola E, Prati D, Suter F, et al. Age at infection affects the long-term outcome of transfusionassociated chronic hepatitis C. Blood 2002;99:4588–91.


27. Tong MJ, el-Farra NS, Reikes AR, et al. Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med 1995;332:1463–66.


28. Poynard T, Ratziu V, Charlotte F, et al. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. J Hepatol 2001;34:730–39.


29. Подымова С.Д., Азов А.Г. Вирусные гепатиты у пожилых пациентов. Особенности эпидемиологии, клинической картины, профилактики и лечения. Вирусные гепатиты. Достижения и перспективы. 2001. № 1. C. 3–12.


30. Simmonds P, Mellor J, Craxi A, et al. Epidemiological, clinical and therapeutic associations of hepatitis C types in western European patients. J Hepatol 1996;24:517–24.


31. Ikeda K, Saitoh S, Koida I, et al. A multivariate analysis of risk factors for hepatocellular carcinogenesis: a prospective observation of 795 patients with viral and alcoholic cirrhosis. Hepatology 1993;18:47–53.


32. Ohishi W, Kitamoto M, Aikata H, et al. Impact of aging on the development of hepatocellular carcinoma in patients with hepatitis C virus infection in Japan. Scand. J Gastroenterol 2003;38:894–900.


33. Hoshida Y, Ikeda K, Kobayashi M, et al. Chronic liver disease in the extremely elderly of 80 years or more: clinical characteristics, prognosis and patient survival analysis. J Hepatol 1999;31:860–66.


34. Kobayashi S, Takeda T, Enomoto M, et al. Development of hepatocellular carcinoma in patients with chronic hepatitis C who had a sustained virological response to interferon therapy: a multicenter, retrospective cohort study of 1124 patients. Liver Int 2007;27:186–91.


35. Zignego AL, Craxi A. Extrahepatic manifestations of hepatitis C virus infection. Clin Liver Dis 2008;12:611–36.


36. Wali M, Harrison RP, Gow PJ, et al. Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut 2002;51:248–52.


37. D'Souza R, Glynn MJ, Ushiro-Lumb I, et al. Prevalence of hepatitis C-related cirrhosis in elderly Asian patients infected in childhood. Clin Gastroenterol Hepatol 2005;3:910–17.


38. Strader DB, Wright T, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004;39:1147–71.


39. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;49:1335–74.


40. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon α-2b plus ribavirin compared with interferon α-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial. Lancet 2001;358:958–65.


41. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon α-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;347:975–82.


42. Strader DB. Understudied populations with hepatitis C. Hepatology 2002;36(1):226–36.


43. Bresci G, Del Corso L, Romanelli AM, et al. The use of recombinant interferon alfa-2b in elderly patients with anti-HCV-positive chronic active hepatitis. J Am Geriatr Soc 1993;41:857–62.


44. Horiike N., Masumoto T., Nakanishi K, et al. Interferon therapy for patients more than 60 years of age with chronic hepatitis C. J Gastroenterol Hepatol 1995;10:246–49.


45. Van Thiel DH, Friedlander L, Caraceni P, et al. Treatment of hepatitis C virus in elderly persons with interferon alpha. J Gerontol A Biol Sci Med Sci 1995;50:330–33.


46. Alessi N, Freni MA, Spadaro A, et al. Efficacy of interferon treatment in elderly patients with chronic hepatitis C. Infez Med 2003; 11:208–12.


47. Koyama R, Arase Y, Ikeda K, et al. Efficacy of interferon therapy in elderly patients with chronic hepatitis C. Intervirology 2006;49:121–26.


48. Imai Y, Kasahara A, Tanaka H, et al. Interferon therapy for aged patients with chronic hepatitis C: improved survival in patients exhibiting a biochemical response. J Gastroenterol 2004;39:1069–77.


49. Shiratori Y, Ito Y, Yokosuka O, et al. Antiviral therapy for cirrhotic hepatitis C: association with reduced hepatocellular carcinoma development and improved survival. Ann Intern Med 2005;142:105–14.


50. Nudo CG, Wong P, Hilzenrat N, et al. Elderly patients are at greater risk of cytopenia during antiviral therapy for hepatitis C. Can. J Gastroenterol 2006;20:589–92.


51. Honda T, Katano Y, Urano F, et al. Efficacy of ribavirin plus interferon-alpha in patients aged > or = 60 years with chronic hepatitis C. J Gastroenterol Hepatol 2007;22:989–95.


52. Iwasaki Y, Ikeda H, Araki Y, et al. Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C. Hepatology 2006;43:54–63.


53. Gupta SK, Glue P, Jacobs S, et al. Singledose pharmacokinetics and tolerability of pegylated interferon-α2b in young and elderly healthy subjects. Br J Clin Pharmacol 2003; 56:131–34.


54. Martin NE, Modi MW, Reddy KR. Characterization of pegylated (40 kDa) interferon α-2a in the elderly. Hepatology 2000;32(4):755.


55. Floreani A, Minola E, 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; 54:549–50.


56. Antonucci G, Longo MA, Angeletti C, 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 yr. Am J Gastroenterol 2007;102:1383–91.


57. Maddrey WC, Afdhal NH, Jacobson IM, et al. HCV management today and tomorrow: tailoring therapy by genotype, viral response, and novel targets. Gastroenterol Hepatol 2007;3:4–14.


58. Arase Y, Ikeda K, Suzuki F, et al. Long-term outcome after interferon therapy in elderly patients with chronic hepatitis C. Intervirology 2007;50:16–23.


59. Marotta P, Feinman SV, Ghent C, et al. Final results of the canadian POWeR (Pegetron Prospective Optimal Weight-Based Dosing Response) program. Sustained virologic response to weight-based peginterferon alfa2b + ribavirin in a large, mixed, community and academic observational study. Hepatology 2007;46:254.


60. Fabris P, Floreani A, Carlotto A, et al. Impact of liver steatosis on virological response in elderly Italian patients with chronic hepatitis C treated with peg-interferon alpha-2b plus ribavirin. Aliment Pharmacol Ther 2005;21:1173–78.


61. McHutchison JG, Lawitz EJ, Shiffman ML, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. N Engl J Med 2009;361:580–93.


62. Bellentani S, Pozzato G, Saccoccio G, et al. Clinical course and risk factors of hepatitis C virus related liver disease in the general population: report from the Dionysos study. Gut 1999;44:874–80.


63. McHutchison JG, Manns M, Patel K, et al. Adherence to combination therapy enhances sustained response in genotype-1-infected patients with chronic hepatitis C. Gastroenterology 2002;123:1061–69.


64. Jacobson IM, Brown RS Jr, Freilich B, et al. Peginterferon alfa-2b and weight-based or flat-dose ribavirin in chronic hepatitis C patients: a randomized trial. Hepatology 2007; 46:971–81.


65. Nomura H, Tanimoto H, Kajiwara E, et al. Factors contributing to ribavirin-induced anemia. J Gastroenterol Hepatol 2004; 19:1312–27.


66. Gish RG, Arora S, Nelson D, et al. End-oftreatment response in therapy-naive patients treated for chronic hepatitis C with viramidine in combination with pegylated interferon α-2a. Hepatology 2004;40:519.


67. Horikawa N, Yamazaki T, Izumi N, et al. Incidence and clinical course of major depression in patients with chronic hepatitis type C undergoing interferon-αtherapy: a prospective study. Gen Hosp Psychiatry 2003;25:34–8.


68. www.mhlw.go.jp


69. Arias E. United States life tables, 2002. Natl Vital Stat Rep 2004;53:1–38.


70. Mindikoglu AL, Miller RR. Hepatitis C in the elderly: epidemiology, natural history, and treatment. Clin Gastroenterol Hepatol 2009;7:128–34.


71. Cainelli F. Hepatitis C virus infection in the elderly: epidemiology, natural history and management. Drugs Aging 2008;25:9–18.


72. www.gks.ru/free_doc/new_site/population/ demo/demo26.htm


73. Marcus EL, Tur-Kaspa R. Chronic hepatitis C virus infection in older adults. Clin Infect Dis 2005;41:1610–11.


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