Hepatitis C Treatment Is Completed, Now What?

Once you have completed hepatitis C treatment, what’s next? There are many different follow-up tests and exams you may need in your post-treatment recovery.

Tests and physical exams

Your doctor may recommend

• Blood work: A CBC (complete blood count) and a hepatic panel may be done post-treatment
• 4 to 12 weeks after your hepatitis C treatment is completed, you will have a quantitative HCV RNA test. The RNA (viral load test) will detect and measure the number of hepatitis C viral particles in the blood. If you show to be non-detected 12 weeks after treatment has been completed, you have achieved SVR12 (sustained virologic response) and are considered cured.
• Your physician may schedule physical exams and blood work in order to monitor your progress in recovery.
• Ultrasound tests are normally performed post-treatment recovery, every 6 months to once a year, depending on your liver condition.

If you have ever had hepatitis B, you should be closely monitored for hepatitis B reactivation with blood work and physical exams during your recovery from hepatitis C treatment.

The following AASLD-IDSA's guidance for post-hepatitis C treatment is recommended based on the degree of fibrosis and risk of reinfection.

SVR-12 patients with minimal to moderate fibrosis (FO-F2)

After achieving SVR12, if the patient has little to mild fibrosis, the physician may test and monitor the patient until 24 weeks after treatment, but studies show most patients do not have further liver damage caused by HCV-related fibrosis.

SVR-12 patients with advanced fibrosis (F3-F4)

Liver damage with fibrosis may improve in patients, but they are considered high risk for developing hepatocellular carcinoma (HCC). Regular follow-up tests and monitoring are recommended. Blood tests and an abdominal ultrasound every 6 months is recommended.

Patients with cirrhosis (F4 fibrosis) should also have an upper endoscopy to screen for varices (enlarged veins in the lining of the esophagus).

SVR-12 patients with persistent abnormal liver tests

Recommended tests are needed to evaluate possible liver-related conditions such as fatty liver disease, iron overload, alcohol use, or other conditions.

SVR-12 patients with ongoing risk of HCV reinfection

Even after achieving an SVR12, you will always test positive for hepatitis C antibodies. This does not mean you have an active virus. Antibodies show you have been either exposed or had hepatitis C at one time. Think of it as a snapshot that the virus was once there. Having hepatitis C antibodies does not mean you are immune and protected from ever becoming infected again, so be proactive with reducing risks of re-infection. If you are at risk, it is recommended you have continued hepatitis C tests.

Patients who did not achieve SVR

Follow-up blood tests should be done every 6 to 12 months including a liver function panel, CBC, and international normalized ratio. Patients should be evaluated for re-treatment with additional treatment options. Patients should avoid alcohol and medications/drugs that are harmful to the liver.

Patients with advanced fibrosis (F3-F4) should receive regular blood tests, ultrasounds, and endoscopies every 6 months due to the high risk of liver cancer. For patients who have varices present, appropriate procedures and medications may need to be done. A diet consultation is recommended with a registered dietitian and physician who can design a diet best suited for your liver condition.¹