Healthy liver in senior adult after hepatitis C treatment.

Over 65? How Dual Therapy Can Still Fight Hepatitis C

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Don't let age be a barrier: Discover how dual therapy effectively combats Hepatitis C genotype 2, even with an ALT flare."

Hepatitis C virus (HCV) can manifest differently, with varied biochemical and virological patterns. For those with genotype 2 chronic hepatitis C (CHC G2), guidelines often recommend dual therapy—a combination of pegylated interferon plus ribavirin. This approach has shown high success rates in achieving a sustained virological response (SVR), meaning the virus remains undetectable long after treatment ends.

While the benefits of dual therapy are well-documented for younger patients, its role in older adults (over 65) experiencing an alanine aminotransferase (ALT) flare—a sudden elevation of liver enzymes—is less clear. An ALT flare can signal rapid disease progression, making effective treatment crucial.

This article explores the effectiveness of dual therapy in older patients with CHC G2 who experience ALT flares. By examining real-world cases, we'll demonstrate how this treatment can achieve excellent virological responses, even in the face of factors that typically predict poorer outcomes.

Dual Therapy: A Ray of Hope for Older Patients with Hepatitis C

Healthy liver in senior adult after hepatitis C treatment.

Italian researchers presented two compelling case studies that highlight the potential of dual therapy in older individuals with CHC G2 and ALT flares. The patients, a 69-year-old woman and a 65-year-old man, both presented with elevated liver enzymes and other risk factors.

Despite these challenges, both patients achieved remarkable results with dual therapy:

Rapid Virological Response (RVR): Both patients achieved undetectable HCV-RNA levels within the first four weeks of treatment.
Complete Early Virological Response (CEVR): HCV-RNA remained undetectable at week 12.
End-of-Treatment Response (EOT): The virus was still undetectable at the end of the 24-week treatment course.
Sustained Virological Response (SVR): Most importantly, both patients maintained undetectable HCV-RNA levels 24 weeks after completing treatment, indicating a successful and lasting response.

These cases suggest that dual therapy can be a valuable option for older patients with CHC G2 and ALT flares, even when other factors suggest a less favorable prognosis. The researchers emphasize the importance of considering dual therapy in these individuals to prevent disease progression and improve overall outcomes.

What This Means for You

If you're over 65 and have hepatitis C genotype 2, an ALT flare doesn't automatically disqualify you from effective treatment. These cases demonstrate that dual therapy can still be a viable option, leading to sustained viral response and improved liver health.

Talk to your doctor about whether dual therapy is right for you. They can assess your individual risk factors and determine the best course of action.

Even with new drugs emerging, these findings highlight the continued importance of dual therapy in specific patient populations. Don't let age or ALT flares stand in the way of exploring your treatment options and achieving a healthier future.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is dual therapy for Hepatitis C?

Dual therapy, combining pegylated interferon and ribavirin, is a treatment approach for Hepatitis C genotype 2 (CHC G2). It's considered when individuals have chronic Hepatitis C. This treatment is significant because it aims to achieve a sustained virological response (SVR), meaning the virus becomes undetectable long after the treatment concludes. This is critical because it halts the progression of liver damage and improves the patient's long-term health.

What does an ALT flare mean?

An ALT flare refers to a sudden increase in alanine aminotransferase (ALT) levels, a liver enzyme, in the blood. This elevation can signal potential liver damage or rapid disease progression in individuals with chronic Hepatitis C. It's important because, in the context of Hepatitis C, it can indicate a worsening condition, making prompt and effective treatment essential to prevent further liver injury and complications like cirrhosis or liver cancer. For older patients, particularly those over 65, an ALT flare can be a sign of advanced liver disease.

What is a Sustained Virological Response, and why is it important?

Sustained virological response (SVR) is a key outcome in Hepatitis C treatment. It means that the Hepatitis C virus (HCV) remains undetectable in the patient's blood for a significant period after completing treatment, typically 24 weeks. An SVR indicates the treatment has successfully cleared the virus from the body, stopping the disease progression and reducing the risk of long-term liver complications. For individuals with CHC G2, achieving an SVR with dual therapy signifies a successful treatment outcome and improved liver health.

What is the significance of the case studies mentioned with dual therapy?

Dual therapy, consisting of pegylated interferon and ribavirin, is a treatment approach that has shown promise for those with Hepatitis C genotype 2 (CHC G2). The two case studies highlighted that patients over 65 with CHC G2 and ALT flares can achieve excellent outcomes with dual therapy. Key indicators of success include a Rapid Virological Response (RVR), Complete Early Virological Response (CEVR), End-of-Treatment Response (EOT) and Sustained Virological Response (SVR). It is important because it suggests dual therapy can still be effective even in older patients with challenging conditions, offering them a chance to prevent disease progression and improve their overall health.

What if I am over 65, have Hepatitis C genotype 2, and have an ALT flare, what should I do?

If you are over 65 and have Hepatitis C genotype 2 (CHC G2) experiencing an ALT flare, it doesn't necessarily mean that treatment is not an option. The studies presented demonstrate that dual therapy can still be an effective choice, leading to a Sustained Virological Response (SVR). This suggests that older patients with these conditions can benefit from treatment, preventing the disease from progressing and maintaining liver health. It is vital to consult with a healthcare provider to discuss the best treatment plan.