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Background: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated.Aim: To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients.Methods: Patients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review.Results: A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility.Conclusions: As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported. [ABSTRACT FROM AUTHOR]

Objectives: We undertook this study to determine if treatment candidacy and outcomes were similar between elderly and non-elderly patients.Methods: This was a prospective cohort study that screened 4,025 patients with chronic hepatitis C for HCV antiviral treatment at 24 Veterans Affairs Medical Centers throughout the country. We used multivariable logistic regression to determine whether there was an independent association between being elderly (age > 60 vs. Results: 364 of the 4,025 patients (9%) were over the age of 60. Only 25% of patients over the age of 60 were considered to be treatment candidates by the evaluating clinician, and only 10% were started on treatment. After adjustment for potential confounders, older age remained associated with a lower likelihood of being considered a treatment candidate (adjusted OR = 0.43; 95% CI: 0.30-0.61). Although based on a small sample of elderly treated patients (n = 35), being elderly did not appear to be associated with a lower likelihood of achieving SVR (adjusted OR = 1.54; 95% CI: 0.46-5.15).Conclusion: Among veterans over the age of 60 with chronic hepatitis C who are referred for treatment, relatively few are considered treatment candidates and an even smaller number are ultimately treated. After adjusting for co-morbidities, age remains a strong predictor of not being a treatment candidate. In contrast, older age does not seem to adversely affect treatment outcomes and side effects. [ABSTRACT FROM AUTHOR]