is it possible to have hep c but still no cirrhosis after 65?

Question

There have been several recent posts alluding to the fact that many people with hep c develop cirrhosis by about age 65. I also remember seeing a study that said that it doesn't matter how old you are when you get infected, cirrhosis tends to develop around age 65. Often age at infection is said to be a factor influencing disease progression--older age at infection means faster progression--but it may be that progression is just age-related. On the other hand my hepatologist says that he knows of patients in their 70s and 80s with hep c and only mild damage. So, I just thought it would be interesting to ask on this forum, are there anyone out there past 65 with only mild damage?

Bali05 · Answer

A close relative of mine is soon to be 85 years old and is geno 1.
Recent PCR showed VL of 7k IU/ml last Fibroscan F1. He was diagnosed
during an operation when he was 70.

b

curiouslady1 · Answer

I am 64 with f=0 and my infection lasted for 40 years.  The virus is undetectable in my blood now after a week and half dosing with two oral drugs.  My ALT and AST are 13 and 12.

milliehepc · Answer

I am 63.
Got it at age 26 (my best estimate)
Just got diagnosed after liver biopsy (first one - waited to a long time to do this) with Stage 2/3.  Geno Type 1.I'm considering a Trial called ABT-450.  Have to make a decision by Thursday.  It would appear that time is of the essence.

Well, let's just hope the study is off (for many our sake) - I'm hopeful particularly when others are much older and yet to develop the end stage.

Millie

BelB64 · Answer

"It clearly states regardless of age at time of infection...."

That's what makes the finding "Except females with non genotype1 infected before age 37 who won't on average get cirrhosis until age 89" so interesting. The study seems to be very precise and thorough. I can't believe they would print results like this if the sampling of women was tiny. There HAS to be some reason that this population doesn't progress to cirrhosis until 20 years after everyone else. We know women generally progress slower but this study says most genotype one men and women and non genotype 1 men will progress to cirrhosis by age 65. Again this must mean that genotype 1 in women is much more potent than genotypes 2 and 3 especially when infected at a young age. I wish the study would have explained some type of theory why this is the case when earlier it is stated that fibrosis din't progress faster or slower due to genotype.

jmjm530 · Answer

While I don't believe I personally ever used the statistic in discussions here, I believe the "20 percent" figure cited refers to a 20% chance of developing cirrhosis after 20 years of infection. http://linkinghub.elsevier.com/retrieve/pii/S1542356505005276

jmjm530 · Answer

HCA: shall be glad to see the back of 'only 20% develop cirrhosis' cliche which is still being bandied about. 
----------
Ah, it always seems to come down to differing opinions on when to treat :)

How does convergence of cirrhosis at age 65 affect someone let's say 50 who is only stage 1 or 2 and is infected at an early age? I'd say he -- and especially she -- has time to wait for better stuff! Also, not sure if the cliche has been bandied around without a time limit attached, i.e. "in x years, etc". But still, the convergence at 65 is good to know for those approaching that time.

-- Jim

HCA · Answer

Yes I think slower progression at early age infection is still valid,but the long term prognosis evens out as per the study.
I shall be glad to see the back of 'only 20% develop cirrhosis' cliche which is still being bandied about.

jmjm530 · Answer

OK. But my understanding is that age of infection is still a positive predictor of both SVR and fibrosis progression (less progression) even if things appear to converge at age 65. In other words, someone infected earlier would tend to have slower progression let's say in their 20's, 30's, 40's or 50's which appeared to happen with many of us, including myself. Did the study break down progression in terms of BMI? That was my point in regard to the geno 2 thing. I will try and read the study later :)

-- Jim

HCA · Answer

Jim-read the study! It clearly states 'regardless at age at time of infection'

Bill-you are probably right,however there is something odd about the sampling.
The study must include treatment failures and non-treaters right?
If we accept that geno 1 (the largest popilation) has an SVR rate of say 40% -the most optimistic figure 46%-includes young 'uns ect.Geno 2 has a SVR rate (female gender?) of  80%.
Therefore the groups that the data is drawn from are so massively different in empirical terms that it may be skewed,Food for thought!

jmjm530 · Answer

Forgot to mention that another other predictor of slower progression is female gender.

jmjm530 · Answer

It says most people will develope cirrhosis around age 65 regardless of genotype. HOWEVER women with non-genotype 1, who are infected before age 37 won't on average get cirrhosis until they are 89!!!  
--------------------------------------------------------------

I profess to not having read the study, but a couple of thoughts anyway. First, we have one predictor of slower progression, i.e. younger age of infection. As to genotype, I wonder if there have been breakdowns as to BMI, etc. Genotype 1's tend to be more common in the U.S., for example, where we are on average heavier than the Europeans. So, possibly, it's not the genotype but the body type.

BelB64 · Answer

I of course meant in the last sentence of my previous post "This tells me that despite information to the contrary in the article there is SOMETHING about genotype 1 especially in women, that promotes progression of the liver fibrosis and and liver disease that genotypes 2 and 3 don't."

BelB64 · Answer

I've read this article many times and there is a very interesting stat that is mentioned almost in passing. It says most people will develope cirrhosis around age 65 regardless of genotype. HOWEVER women with non-genotype 1, who are infected before age 37 won't on average get cirrhosis until they are 89!!!  This tells me that despite the information to the contrary in the article, there is SOMETHING about genotype 1, especially in women , that promotes progression of the liver fibrosis and liver disease that genotypes 1 and 2 don't. How else could the almost 25 year difference in average onset of cirrhosis be explained?

HCA · Answer

There you go!
http://www.medscape.com/viewarticle/554637

burned74 · Answer

My friends dad is well into his 80s and thinks he got hep c over 50 years ago.

The stats I have seen are that 20 per cent advance to cirrhosis and that cancer is only possible with those with cirrhosis. the "85 per cent advance to cirrhosis or cancer"  number seems quite a bit off.

I have not seen anything more recent but I imagine that the 20 per cent number is increasing some based upon the hep c population aging. Anyone got any number that is more recent?

HCA · Answer

The old saying that only 20% develop cirrhosis is years out of date.
It is true that recent stats. demomstrate that most will develop cirrhosis at around age 65 as you say.
However you are an individual not a statisic.
A biopsy will provide a prognosis in your particular case.
Don't assess your future on averages.

fretboard · Answer

Sure it's possible, last time I checked only 85% advance to cirrhosis or cancer.  The other 15%, the fda doesn't say what happens to them.  Maybe they tx or maybe they are exposed to getting something else from this ugly virus.  Sounds like a russian roulette type of question. lol  Hope you find the answers you're looking for.  later

Marcia2202 · Answer

That was right on the spot... She actually got it in France, but in a hospital, not a festival :-)

pigeonca · Answer

I was 63 when diagnosed.  Stage 2 Grade 2.  So if I hadn't successfully treated, I'd imagine cirrhosis would still be quite far down the road. Nevertheless, I didn't want to wait and find out.