From the Guidelines
After completing hepatitis C treatment, patients should be followed up with blood tests to confirm cure, and those with cirrhosis require ongoing surveillance with ultrasound examinations every 6 months to monitor for hepatocellular carcinoma. The follow-up approach for hepatitis C patients after treatment typically involves confirming sustained virologic response (SVR) and monitoring for potential complications. According to the American Gastroenterological Association Institute clinical practice update 1, SVR is tantamount to virologic cure, with fewer than 1% of patients relapsing after SVR. For non-cirrhotic patients who achieve SVR, the EASL recommendations suggest retesting for ALT and HCV RNA at 48 weeks post-treatment, then discharging the patient if ALT is normal and HCV RNA is negative 1. However, cirrhotic patients with SVR should undergo surveillance for hepatocellular carcinoma (HCC) every 6 months by means of ultrasound, as recommended by the EASL 1. Additionally, patients with ongoing risk factors for hepatitis C, such as people who inject drugs (PWID) or men who have sex with men (MSM) with ongoing risk behavior, should be tested annually for HCV reinfection 1. It is essential to maintain regular primary care visits and avoid alcohol, which can further damage the liver. Some patients may need additional monitoring if they have other liver conditions or if they experienced significant liver damage before treatment. Key aspects of follow-up care include:
- Confirming SVR through blood tests
- Monitoring for hepatocellular carcinoma in cirrhotic patients
- Annual testing for HCV reinfection in patients with ongoing risk factors
- Regular primary care visits
- Avoiding alcohol to prevent further liver damage.
From the Research
Hepatitis C Follow-up After Treatment
- The follow-up period for patients with hepatitis C after treatment is crucial in determining the sustained virologic response (SVR) 2.
- A study published in 2010 found that a 12-week posttreatment follow-up is as relevant as a 24-week follow-up in determining SVR in patients with hepatitis C virus receiving pegylated interferon and ribavirin 2.
- The assessment of serum HCV-RNA 12 weeks after the end of treatment, using a highly sensitive transcription-mediated amplification (TMA) assay, has a positive predictive value (PPV) of 99.7% in predicting SVR 2.
Sustained Virologic Response (SVR)
- SVR is defined as undetectable serum HCV-RNA at 24 weeks posttreatment follow-up 2, 3.
- Patients who achieve SVR have improved survival and liver-related morbidity compared to non-SVR patients 4, 5, 6.
- A systematic review published in 2014 found that new, simpler therapeutics using direct-acting antivirals can eradicate HCV without concomitant interferon, resulting in high SVR rates 3.
Long-term Outcomes
- Long-term follow-up studies have shown that patients with SVR have a reduced risk of liver-related complications, such as hepatocellular carcinoma and cirrhosis 4, 5, 6.
- A study published in 2013 found that patients with chronic hepatitis C who achieved SVR had a 99.33% survival rate after therapy for HCV infection, with a median follow-up of 8.6 years 5.
- Another study published in 2011 found that SVR has a profound impact on the natural course of chronic hepatitis C, with a risk of late HCV recurrence of <2% 6.