Efficacy of dual therapy in patients >65 years old with alanine transaminase flare during chronic hepatitis C genotype 2

Hepatitis C virus (HCV)-related chronic hepatitis is characterized by different clinical outcomes as well as by distinct biochemical and virological patterns. According to guidelines concerning dual therapy, high rates of sustained virological response (or HCV-RNA undetectable 24 weeks after the end of antiviral treatment) has been obtained in patients with persistent HCV infection, caused by genotype 2 (CHC G2). Dual therapy (pegylated interferon plus ribavirin) might be an useful strategy not only in the treatment of younger patients (≤65 years old, that is generally considered as age limit for the beginning of the antiviral treatment) but also of older patients (>65 years old) experiencing an alanine aminotransferase (ALT) flare (with value of ALT-alanine transaminase ≥400 U/L). In fact the progress of fibrosis can advance quicker exactly during the transaminase breakthrough. We report our experience in the treatment of two Italian patients with CHC G2, one of them was a never treated (naive) woman, whereas the other was a previously treated man with several co-morbidities. Both patients presented an excellent virological response to dual therapy despite unfavorable predictive factors, such as old age (>65 years), ALT flare and possible moderate hepatic fibrosis.