Viral Hepatitis

Diffuse liver inflammation caused by specific hepatotropic viruses.

The course of viral hepatitis is often more aggressive in elderly than in younger patients, although the prevalence is lower.

The elderly patient with viral hepatitis may initially be asymptomatic or may present with nonspecific complaints such as nausea, fatigue, and loose stools.

Acute hepatitis A is much less common in the elderly than in younger persons. More than 70% of elderly persons have serologic evidence of previous infection and are therefore immune. Such immunity is even more pronounced in developing countries, where relatively poor hygiene and sanitation practices have previously exposed a high proportion of elderly patients to the virus. Hepatitis A in the elderly often results in a lower serum aminotransferase level and a more prolonged cholestatic course than in younger persons. The risk of death is increased substantially, from 7/10,000 in persons aged 15 to 24, to 400/10,000 in those >= 65.

Acute hepatitis B and C are also less common in the elderly than in younger persons. These infections have a more prolonged cholestatic course, and the likelihood that the infection will become chronic is greater. For example, in younger patients with hepatitis B, 5 to 15% of acute cases become chronic, compared with up to 43% in elderly patients. Treatment of hepatitis C with interferon, whether or not combined with ribavirin, results in poorer clearance of the virus in the elderly compared with treatment in younger persons. This poor clearance is presumably due to the diminished function of the immune system, including a progressive loss of T-lymphocyte activity. Elderly patients infected with hepatitis B are also less likely to respond to lamivudine therapy.