What does HCV (Hepatitis C Virus) s/p (status post) SVR (Sustained Virological Response) mean?

HCV s/p SVR: Definition and Clinical Significance

HCV s/p SVR means a patient with Hepatitis C Virus infection who has achieved a Sustained Virologic Response after antiviral treatment—essentially, they are cured of the infection. 1

What SVR Represents

SVR is tantamount to virologic cure, with fewer than 1% of patients experiencing late relapse after achieving this endpoint. 1 Specifically:

• SVR is defined as undetectable HCV RNA (<50 IU/mL) at 12 weeks after completion of treatment (SVR12), which has replaced the older 24-week endpoint as the standard measure of cure. 1
• SVR12 represents permanent viral eradication in more than 99% of patients, making it equivalent to a cure rather than just viral suppression. 2, 3
• The risk of late virologic relapse after confirmed SVR is less than 2% even with the most stringent follow-up criteria. 4

Clinical Implications of "s/p SVR" Status

For Non-Cirrhotic Patients

Patients without advanced fibrosis (stages 0-2) who achieve SVR generally have excellent outcomes with resolution of liver disease and do not require ongoing HCC surveillance. 1, 2 These patients:

• Should have HCV RNA confirmed undetectable at 48 weeks post-treatment as routine practice. 1
• Do not require routine HCV RNA testing beyond 48 weeks unless they have ongoing risk factors for reinfection (active injection drug use, high-risk sexual behavior). 1, 3
• Can be considered cured and discharged from hepatitis C-specific care if liver enzymes normalize. 3

For Cirrhotic Patients (Stage 3-4 Fibrosis)

Patients with cirrhosis who achieve SVR remain at significant residual risk for complications and require indefinite surveillance, despite being virologically cured. 1, 2 Specifically:

• HCC surveillance with liver imaging ± AFP must continue twice annually indefinitely, as the annual HCC risk remains 0.3-2.4% even after SVR. 1, 2, 3
• Initial endoscopic screening for esophagogastric varices is required for all cirrhotic patients, independent of SVR status. 1
• Repeat endoscopy should be performed at 2-3 years if no varices or small varices were found initially. 1, 3
• If no varices are identified at the 2-3 year follow-up and there are no other risk factors for portal hypertension progression, cessation of further endoscopic screening can be considered. 1

Common Clinical Pitfalls

Anti-HCV antibody testing is inappropriate for assessing cure status, as antibodies persist indefinitely regardless of whether the patient achieved SVR. 3 Only HCV RNA testing (qualitative or quantitative PCR with detection limit ≤25-50 IU/mL) can distinguish active infection from past resolved infection. 3

The notation "s/p SVR" does not mean the patient is immune to reinfection. Patients with ongoing risk behaviors require annual HCV RNA surveillance, as reinfection risk is estimated at 1-5% per year in high-risk populations (people who inject drugs, men who have sex with men with ongoing risk behavior). 3

For cirrhotic patients, HCV RNA surveillance alone is insufficient—these patients require comprehensive monitoring including HCC imaging surveillance every 6 months and periodic endoscopic evaluation for varices, regardless of their SVR status. 1, 2, 3