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More than 4 million people have been exposed to hepatitis C virus (HCV) in the United States. Although the rate of new HCV infections has decreased in recent decades because of improved blood screening measures and other efforts, the number of HCV-infected older adults with long-term infection has increased.
Aging-Related Mechanisms
“Aging-related mechanisms that have been postulated to increase the risk of liver disease outcomes in the setting of HCV infection include a greater vulnerability to environmental factors, such as oxidative stress, with increasing age; reduction in the rate of hepatic flow; reduced mitochondrial capacity; impaired immunity; and increased carcinogenic potential caused by a reduced ability to repair DNA.”7,8 In a study of patients who acquired infection during transfusion, those aged 50 years or older at the time of infection developed hepatocellular carcinoma in 15 years (mean) vs 32 years among those who were younger than 50 years at the time of infection.6
Reid et al stated that, “HCV infection is a chronic inflammatory process leading to not only hepatic inflammation but also persistent systemic inflammation, which has been associated with extrahepatic outcomes that are also common with aging.” In addition to a greater risk for liver cancers, a study of adults ≥65 years linked HCV infection to increased risk for intrahepatic (adjusted odds ratio [aOR], 3.40) and extrahepatic (aOR, 1.90) bile duct cancer, anal cancer (aOR, 1.97), myelodysplastic syndrome (aOR, 1.56), pancreatic cancer (aOR, 1.23), nonmelanoma nonepithelial skin cancer (aOR, 1.53), and diffuse large B-cell lymphoma (aOR, 1.57).9 Other research indicates an increased risk for diabetes, kidney disease, cardiovascular disease, and neuropsychological and neurocognitive impairment among older HCV-infected adults.