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Background In China,patients with hepatitis C virus (HCV)-associated liver disease are getting older,and thus the number of deaths due to such disease is increasing.The efficacy of combination therapy with ribavirin and interferon for chronic HCV infection in elderly patients has not been fully clarified.The aim of the present study was to evaluate the efficacy and tolerability of the combination therapy in the elderly patients.Methods Sixty-eight chronic hepatitis C patients,who received the combination therapy,were classified into two age groups:elderly group (＞60 years,n=25) and non-elderly group (＜60 years,n=43).Rapid virological response,complete early virological response,sustained virological response,relapse,non-response rate,and safety were compared between the elderly group and non-elderly group.Results Overall sustained virological response was lower in the elderly group than non-elderly group (44％ vs.75％,P=0.012,OR=0.270,and 95％ C/ 0.095-0.768).Among patients with HCV genotype 1,sustained virological response was lower in the elderly group than non-elderly group (45％ vs.77％,P=0.015,OR=0.247,95％ C/ 0.078-0.781).The proportions of dose reduction due to laboratory abnormalities were significantly higher in the elderly group than non-elderly group (60.0％ vs.32.6％,P=0.027).Multiple binary Logistic regression analysis confirmed that patient age was an associated factor for sustained virological response.Conclusion Among patients with HCV genotype 1,the elderly patients had lower sustained virological response than non-elderly patients during pegylated interferon-alpha-2a plus ribavirin combination therapy.