What follow-up care is needed for someone with hepatitis C?

From the Guidelines

Follow-up care for someone with hepatitis C involves regular monitoring by a healthcare provider, typically every 3-6 months, to assess liver function through blood tests like ALT, AST, and viral load measurements, with a focus on sustained virologic response (SVR) confirmation at 12 weeks post-treatment and lifelong surveillance for hepatocellular carcinoma in those with cirrhosis, as recommended by the most recent guidelines 1. After completing direct-acting antiviral treatment, patients need testing for SVR at 12 weeks post-treatment to confirm cure.

• Those with advanced liver disease (cirrhosis) require more intensive monitoring, including:
  • Ultrasound examinations every 6 months
  • Endoscopic screening for varices, as outlined in the American Gastroenterological Association guidelines 1.
• Patients should avoid alcohol completely, maintain a healthy diet low in processed foods and sugar, exercise regularly, and avoid medications that can stress the liver (like high-dose acetaminophen).
• Even after achieving cure, those with cirrhosis need lifelong surveillance for hepatocellular carcinoma, with surveillance for HCC with liver imaging ± serum AFP pursued twice annually for an indefinite duration in all patients with stage 3 fibrosis or liver cirrhosis post-SVR, as recommended by the American Gastroenterological Association 1.
• Vaccination against hepatitis A and B is recommended if not already immune.
• Patients should also inform healthcare providers about their hepatitis C history, even after cure, as it may influence future medical decisions. This comprehensive follow-up approach is essential because hepatitis C can silently damage the liver over decades, and proper monitoring helps prevent complications and ensures successful treatment outcomes, with the risk of late relapse being very low, as indicated by recent data 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Follow-up Care for Hepatitis C

• Patients with hepatitis C require regular follow-up care to monitor the progression of the disease and the effectiveness of treatment 2.
• The follow-up care may include:
  • Liver function tests to monitor liver damage and inflammation
  • Viral load tests to monitor the level of hepatitis C virus in the blood
  • Liver biopsy to assess the degree of liver fibrosis and cirrhosis
  • Imaging tests such as ultrasound or CT scans to monitor for liver cancer
• The frequency of follow-up visits may vary depending on the individual's condition and the stage of the disease 3.
• Patients who have achieved a sustained virologic response (SVR) after treatment may still require regular follow-up care to monitor for potential complications such as liver cancer and portal hypertension 3.

Treatment Options

• The treatment options for hepatitis C have evolved over the years, with the introduction of direct-acting antivirals (DAAs) such as glecaprevir and pibrentasvir 4, 5, 6.
• These treatments have shown high efficacy and safety profiles, with sustained virologic response rates of over 90% in some cases 4, 5, 6.
• The treatment duration may vary depending on the individual's condition and the stage of the disease, with options ranging from 8 to 16 weeks 4, 5, 6.

Monitoring for Complications

• Patients with hepatitis C are at risk of developing complications such as liver cancer and portal hypertension, even after achieving SVR 3.
• Regular follow-up care is necessary to monitor for these complications and to provide early intervention if necessary 3.
• Non-invasive methods such as liver function tests and imaging tests may be used to monitor for liver damage and inflammation, replacing the need for liver biopsy in some cases 3.