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Hepatitis in the Elderly: Still a Scourge

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Abstract:

Liver disease presents with classic symptoms: fatigue, anorexia that progresses to nausea and vomiting, muscle and joint pain, and jaundice. Its most common cause is viral infection (hepatitis) with one of the hepatotropic hepatitis viruses. Although all types of hepatitis cause liver disease, their modes of transmission differ, and treatment may or may not be an option. In all types of hepatitis, people older than 65 years of age tend to develop more severe disease than those who are younger. Hepatitis A is rare in the United States, usually resolves completely with rest and supportive care, and there is no drug treatment. The Food and Drug Administration has approved several medications for hepatitis B, although comorbidities in the elderly may preclude their use. Hepatitis C is generally treated with interferon alpha and ribavirin in patients who can tolerate these agents. Chronic hepatitis D infection is more aggressive than chronic hepatitis B infection, leading to cirrhosis within two years in 10% to 15% of patients. Treatment with interferon for at least one year is recommended, but may not help. Hepatitis E virus infection—typically associated with large waterborne epidemics and endemic in Asia, Africa, and Mexico—is poorly understood and reported only sporadically in the United States. Consultant pharmacists can provide invaluable input concerning management of patients with hepatitis since few guidelines are available. Treatment is complex and often associated with side effects, and it is costly to treat. Complete adherence is critical. Residents, their families, and long-term care staff will need education and support in treating these patients. Pharmacist involvement is especially important as newly approved agents become available; side effects can cause clinicians and patients to abandon treatment.

Keywords: ADV = Adefovir dipivoxil; Anti-HBc = Hepatitis B core antibody; Anti-HBs = Hepatitis B surface antigen; CDC = Centers for Disease Control and Prevention; ETV = Entecavir; HAV = Hepatitis A; HBV = Hepatitis B; HBcAbIgM = Hepatitis B core antibody IgM; HBeAg = Hepatitis B e antigen; HCC = Hepatocellular cancer; HCV = Hepatitis C; HDV = Hepatitis D virus; HEV = Hepatitis E; Hepatitis; IFN = Conventional interferon; Interferon; LAM = Lamivudine; LdT = Telbivudine; NHANES III = National Health and Nutrition Examination Survey; Nucleoside/nucleotide analogs; Peg-IFN = Pegylated interferon; TDF = Tenofovir disoproxil fumarate; Viral hepatitis

Document Type: Research Article

DOI: http://dx.doi.org/10.4140/TCP.n.2012.472

Publication date: July 1, 2012

More about this publication?
  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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