gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1363Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSКлиническое течение и лечение хронического гепатита С у больных пожилого возрастаChronic hepatitis C course at elderly and therapeutic approachМаевскаяМ. В.MayevskayaM. V.МорозоваМ. А.MorozovaM. A.ГОУ ВПО «1-й Московский государственный медицинский университет им. И.М. Сеченова Росздрава»Russian Federation2011210220112111118Copyright © Маевская М.В., Морозова М.А., 20112011Маевская М.В., Морозова М.А.Mayevskaya M.V., Morozova M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1363

Цель обзора. Обсуждение особенностей течения хронической инфекции вирусом гепатита С у пожилых, эффективности и безопасности противовирусного лечения пациентов данной возрастной группы.Основные положения. В повседневной клинической практике пациенты пожилого возраста с хроническим гепатитом С крайне редко рассматриваются как кандидаты для противовирусного лечения. Такая терапевтическая тактика не всегда оправдана. У лиц в возрасте 65 лет и старше хронический гепатит С протекает тяжелее, чем у молодых пациентов, с более быстрым прогрессированием фиброза и низким уровнем аланинаминотрансферазы. Вследствие таких особенностей цирроз печени (ЦП) у пожилых пациентов наблюдается чаще, чем у более молодых. В ряде исследований показано, что пожилой возраст является независимым фактором риска формирования не только ЦП, но и гепатоцеллюлярной карциномы.Вопрос о целесообразности назначения противовирусной терапии пожилым пациентам необходимо решать индивидуально, учитывая их активность и качество жизни. Для определения стадии заболевания и степени фиброза предпочтительно применение методов, альтернативных биопсии печени. Перед началом лечения необходимо проведение дополнительного обследования, направленного на установление тяжести сопутствующих заболеваний и степени риска их осложнений. Одной из основных проблем в ходе противовирусной терапии является развитие рибавирининдуцированной анемии, что особенно опасно у лиц с заболеваниями сердечно-сосудистой системы. Данное осложнение требует тщательного мониторирования уровня гемоглобина и гематокрита в течение всего периода лечения и при необходимости снижения дозы препаратов согласно разработанным алгоритмам.Заключение. Пожилой возраст не является абсолютным противопоказанием для проведения противовирусного лечения. При решении вопроса о целесообразности назначения противовирусной терапии хронического гепатита С лицам пожилого возраста необходимо четко представлять соотношение возможного вреда, предполагаемой пользы и вероятных последствий отказа от лечения.

The aim of review

The aim of review. To discuss features of course of chronic hepatitis C virus infection at elderly, efficacy and safety of antiviral treatment of patients of this age group.

Original positions

Original positions. In every day clinical practice elderly patients with chronic hepatitis C are extremely rarely considered as candidates for antiviral treatment. Such therapeutic tacticsis is not always justified. At patients in the age of 65 and over chronic hepatitis C has more severe course, than at young patients, with more rapid progression of fibrosis and low level of alanine transaminase. Due to this liver cirrhosis (LC) at elderly patients is more frequent, than at younger subjects. In series of studies it was demonstrated, that elderly age is independent risk factor of development of both LC, and hepatocellular carcinoma. Expediency of prescription of antiviral therapy to elderly patients should be solved individually, taking into account patient’s activity and quality of life. To assess the stage of disease and degree of fibrosis methods, alternative to liver biopsy, are preferable. Before onset of treatment, additional investigation to establish severity of concomitant diseases and risk of their complications should be carried out. One of the basic problems during antiviral therapy is development of ribavirin-induced anemia that is especially dangerous at patients with cardio-vascular diseases. This complication requires careful monitoring of hemoglobin and hematocrit level during the whole period of treatment and, if necessary, decline of drug doses according to established algorithms.

Conclusion

Conclusion. Elderly age is not an absolute contraindication for antiviral treatment. At solving a question of prescription of antiviral therapy for chronic hepatitis C to elderly patients it is necessary to represent clearly the balance of the possible harm and benefits as well as the probable consequences of treatment cancellation.

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The authors declare that there are no conflicts of interest present.