From the Guidelines
After successful treatment for hepatitis C, patients should undergo RNA testing at 12 weeks post-treatment completion to confirm sustained virologic response (SVR), and routine confirmation of SVR at 48 weeks post end of treatment is recommended, as stated in the 2017 EASL recommendations 1.
Post-Treatment Follow-Up
The primary method to verify cure is through undetectable HCV RNA at 12 weeks post-treatment, indicating successful viral clearance.
- For patients who achieve SVR, follow-up testing includes annual HCV RNA testing only if they have ongoing risk factors for reinfection, such as injection drug use or high-risk sexual practices, as recommended by the American Gastroenterological Association Institute 1.
- Patients with advanced fibrosis or cirrhosis (F3-F4) prior to treatment require continued surveillance for hepatocellular carcinoma with ultrasound every 6 months, regardless of SVR status, as their risk remains elevated despite viral clearance, according to the 2017 EASL recommendations 1.
Surveillance and Monitoring
Additionally, those with cirrhosis should have endoscopic screening for varices according to standard guidelines, as stated in the American Gastroenterological Association Institute clinical practice update 1.
- Liver function tests should be monitored periodically in patients with advanced liver disease to assess for improvement in liver function post-SVR, as the risk of liver-related complications remains even after successful treatment, as noted in the 2017 EASL recommendations 1.
Risk of Reinfection
The risk of reinfection should be explained to patients to positively modify risk behavior, and monitoring for HCV reinfection through annual HCV RNA assessment should be undertaken in people who inject drugs or men who have sex with men with ongoing risk behavior, as recommended by the 2017 EASL recommendations 1.
From the Research
Hepatitis C Screening Post Treatment
- Hepatitis C virus (HCV) infection can be cured with treatment, but the long-term outcomes and risk of hepatocellular carcinoma (HCC) are still being studied 2.
- A study found that 96% of patients who achieved sustained virological response (SVR) were HCV-RNA negative at follow-up, and regression of fibrosis was statistically significant 2.
- However, occult HCV infection (OCI) was detected in 4% of patients at 8 and 9 years after the end of treatment, although it was not associated with serious liver disease 2.
- Another study detected HCV RNA in the peripheral blood mononuclear cells (PBMCs) of 20% of patients who achieved SVR, with a low viral load 3.
- The study found that higher post-treatment levels of aspartate transaminase (AST) and liver cirrhosis were predictive of HCV RNA persistence in PBMCs 3.
- The time points of HCV-core-Ag loss and PCR negativity were predictors of SVR 12 in patients treated with sofosbuvir-based antiviral regimen 4.
- A review found that SVR 12 was highly concordant with SVR 24, with high positive and negative predictive values, although there was a higher risk of HCV relapse occurring after post-treatment week 4 5.
- A study found that a sustained virologic response (SVR) was durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin, with 99.1% of patients maintaining undetectable levels of HCV RNA throughout the follow-up period 6.
Risk of Hepatocellular Carcinoma
- A study found that an increased risk of hepatocellular carcinoma (HCC) may persist in the long term after SVR, even in non-cirrhotic patients 2.
- Three previously non-cirrhotic men were diagnosed with HCC 8-11 years after the end of treatment, highlighting the need for long-term follow-up 2.
Monitoring and Follow-up
- The studies suggest that monitoring and follow-up are crucial for patients who have achieved SVR, to detect any potential relapse or development of HCC 2, 3, 6.
- The use of highly sensitive methods to detect HCV RNA and HCV core antigen can help identify patients with occult infection or persistent viremia 2, 3, 4.