There are highly effective direct-acting antivirals that can cure chronic infection of the hepatitis C virus (HCV) for the majority of patients. However, it’s important for health care providers and their patients to understand that clearing this virus does not mean that no more care will be needed.
There are some post-cure guidelines that should be followed. The American Gastroenterological Association (AGA) offers clinical practice guidelines for the care of patients with HCV who have achieved sustained virologic response (SVR).
In other words, after hearing the good news of a patient achieving SVR, here’s what should happen next:
- Retest SVR at 12 and 48 weeks after treatment with direct-acting antivirals, to confirm that the virus is undetectable. (An additional test after 24 weeks can be considered in some patients.)
- If a patient has ongoing risk factors for reinfection, periodic re-testing can be considered after week 48.
- For patients with post-SVR stage 3 fibrosis or cirrhosis, hepatocellular carcinoma should be screened twice a year, for life.
- Patients with post-SVR stages of 0-2 fibrosis do not require hepatocellular carcinoma surveillance.
- If cirrhosis is present, then endoscopic screening for esophageal varices (regardless of SVR) should be conducted, with the screening repeated at 2-3 years post-SVR if no/small varices are present.
In addition, all patients should be educated about risk factors that can encourage fibrosis progression, such as alcohol use, fatty liver, and liver-toxic compounds, so they can reduce the risk of liver harm.
Reinfection is also a possibility. The same prevention measures that guard against hepatitis C infection still hold true for reinfection. That is, patients should be counseled to reduce risky behaviors such as injection drug use, needle sharing, blood-to-blood exposure with another person, and unprotected sexual activity.
Waknine Y. HCV: AGA issues guidelines for post-SVR care. Univadis April 3, 2017.