What labs should be checked after hepatitis C treatment?

Post-Treatment Laboratory Monitoring for Hepatitis C

After hepatitis C treatment, patients should have HCV RNA testing at 12 weeks post-treatment to confirm sustained virologic response (SVR), followed by a final assessment at 48 weeks post-treatment including HCV RNA and ALT testing. 1, 2

Core Post-Treatment Monitoring Protocol

Initial Post-Treatment Assessment

• HCV RNA testing at 12 weeks post-treatment to confirm SVR 1
• Hepatic function panel (liver enzymes) at 12 weeks post-treatment 1

Final Assessment

• HCV RNA and ALT testing at 48 weeks post-treatment 1, 2
• If HCV RNA remains undetectable and ALT is normal at 48 weeks, patients without advanced fibrosis (F0-F2) can be discharged from hepatitis C-specific care 1, 2

Monitoring Based on Fibrosis Status

Patients Without Advanced Fibrosis (F0-F2)

• No additional hepatitis C-specific follow-up is recommended after confirming SVR and normal liver enzymes at 48 weeks 1
• Assessment for other causes of liver disease if liver enzymes remain abnormal despite SVR 1

Patients With Advanced Fibrosis (F3) or Cirrhosis (F4)

• Twice-yearly surveillance for hepatocellular carcinoma (HCC) with abdominal imaging indefinitely 1, 2
• Hepatic function assessment every 6-12 months (hepatic function panel, CBC, INR) 1, 2
• Endoscopic screening for esophageal varices if cirrhosis is present 1
  • Continue endoscopic surveillance per guidelines if varices were present pre-treatment
  • Consider cessation of endoscopic screening if no varices are identified 2-3 years post-SVR 1

Special Monitoring Considerations

Monitoring for Reinfection

• Annual HCV RNA testing for patients with ongoing risk factors (e.g., injection drug use, high-risk sexual behaviors) 2
• The estimated reinfection rate after successful treatment in injection drug users is relatively low (0-4.1 cases per 100 person-years) 3

Evaluation of Persistently Abnormal Liver Enzymes

• Patients with persistently abnormal liver enzymes after achieving SVR should be evaluated for:
  • Alcoholic liver disease
  • Nonalcoholic fatty liver disease
  • Medication effects
  • Other causes of liver injury 1

Evidence Quality and Considerations

• SVR12 (12 weeks post-treatment) has been shown to be highly concordant with SVR24 (24 weeks post-treatment) with positive predictive values >97% 4
• The American Gastroenterological Association, American Association for the Study of Liver Diseases, and European Association for the Study of the Liver all recommend similar post-treatment monitoring protocols 1, 2
• HCV core antigen testing may be an alternative to HCV RNA testing in resource-limited settings, with 97% accuracy in identifying patients who achieve SVR12 5

Common Pitfalls to Avoid

• Don't stop monitoring too early: Final assessment at 48 weeks post-treatment is recommended to confirm sustained cure 1, 2
• Don't miss ongoing liver disease: Patients with cirrhosis remain at risk for HCC even after SVR and require continued surveillance 1
• Don't overlook reinfection risk: Patients with ongoing risk factors should receive annual HCV RNA testing and risk reduction counseling 2
• Don't assume all liver abnormalities are HCV-related: Evaluate for other causes of liver disease if liver enzymes remain abnormal after SVR 1

By following this structured monitoring approach based on fibrosis status, healthcare providers can ensure appropriate post-treatment care while avoiding unnecessary testing for patients who have achieved sustained virologic response.