Kim HI et al. and underestimated disease. An Italian study by Gramen- zi A et al. reported that elderly patients (≥ 65 years) more likely to had advanced liver disease (liver cirrhosis or hepatocellular carcinoma) compared with younger patients (51 % vs. 26 % ; P < 0.0001), but only 20 % of the elderly patients had received antiviral treatment (17). Al- though elderly patients are considered and referred for treatment less often, current treatment guidelines do not suggest an age limitation for antiviral therapy (5-7). Treatment decisions for older patients should be indi- vidualized, based on; the severity of liver disease, poten- tial for serious adverse effects, likelihood of treatment response, and presence of co-morbid conditions. Regard- ing treatment, only patients who have more severe liver involvement than portal fibrosis, with at least moderate inflammation and necrosis and a significant risk of liver cirrhosis during their estimated life expectancy should be considered candidates for therapy. Therapy is contra- indicated for patients with decreased life expectancy due to; severe hypertension, heart failure, or coronary artery disease and for patients with poorly controlled diabetes or obstructive lung disease (5-7). We note that this study is intrinsically limited by its retrospective, single center design and by the small size of the elderly group. Further- more, our investigation of adverse events was limited to medical records. Nevertheless, we believe that this study offers valuable information regarding the therapeutic efficacy and tolerability of PEG-IFN-α and ribavirin com- bination therapy for elderly patients with CHC in Korea. A further large scale, multicenter study is warranted to confirm our results. In conclusion, we found that the SVR rate of PEG-IFN-α plus ribavirin combination therapy was lower in elderly patients (≥ 65 years) with genotype 1. However, the SVR rate among elderly patients with HCV genotype 2 or 3 was comparable to those of non-elderly patients. The HCV genotype was independently associated with SVR. Accordingly, we suggest that PEG-IFN-α plus ribavirin combination therapy might be considered for elderly pa- tients, especially for patients with genotype 2 or 3, with cautious monitoring of adverse events. Acknowledgements This work was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2011-0009814), the National R&D Program for Cancer Control (0620220) and the Korean Health Technology R&D Project (A101834), Ministry for Health, Welfare and Family affairs, Republic of Korea. 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