Follow-Up Care After SVR
The best outcome for hepatitis C treatment is sustained virologic response (SVR), or undetectable levels of HCV in the blood. SVR means the treatment was successful.
SVR is measured in a test that looks for levels of HCV RNA in the blood. This test is given after a person finishes a round of treatment. The doctor may track HCV RNA levels in the middle of treatment, but a person with hepatitis C is not considered ‘cured’ until weeks later.
Achieving SVR 12 weeks after treatment (SVR12) is the main sign that the treatment has worked according to by the American Association for the Study of Liver Diseases and the Infectious Disease Society of America. SVR12 means the body is rid of HCV infection and its liver-related complications.1,2
What is recommended for HCV treatment follow-up after achieving SVR?
After treatment, there are three main categories of people, including:
- Those who have completed treatment and achieved SVR12
- Those who have completed treatment but did not achieve SVR
- Those who did not complete treatment due to side effects and other issues
Achieving SVR with interferon-based treatments or DAA-based treatments comes with a 97 percent or higher chance of reaching undetectable HCV RNA levels long term. Long-term is considered 5 years.2 Follow-up plans depend on the risk of reinfection and the presence of fibrosis or cirrhosis of the liver. These groups include:2,3
Achieved SVR12 and have normal liver function test results and no fibrosis
People with no cirrhosis and normal liver function should be treated as if they never had HCV. Depending on what their doctor prefers, there may be more blood tests to check HCV RNA levels at 6 or 12 months after treatment. This is done to make sure SVR remains.
Achieved SVR12 and have mild fibrosis (F1-F2 fibrosis)
People in this group have minimal scarring or scarring that extends to areas outside the liver that contain blood vessels. Current guidelines say these people do not need more monitoring for HCV or liver conditions. Typically, these people do not have any more HCV-related liver issues. They can be treated in the same way as those with no fibrosis and normal liver function.
Achieved SVR12 and have advanced fibrosis or cirrhosis (F3-F4 fibrosis/cirrhosis)
These people have bridging fibrosis that connects to other fibrosis-containing areas, or cirrhosis of the liver. The risk of HCV-related liver issues is lower than before SVR12. However, this group needs regular ultrasounds of their liver every 6 months to monitor for liver conditions such as liver cancer. They should also be screened for varices if they have not been screened already. Varices are enlarged veins in the esophagus (the tube connecting the mouth and stomach). These develop due to poor blood flow to the liver after a clot or scarring. Varices can cause internal bleeding.
Achieved SVR12 and have an ongoing risk of HCV (regardless of fibrosis or cirrhosis)
These people need regular screenings for HCV RNA to detect reinfection. Other tests to monitor liver enzymes can also be completed. This group may also need counseling on the prevention of HCV reinfection and other support to minimize risky behaviors.
Achieved SVR12 but still have abnormal liver tests
Achieving SVR12 does not mean that the liver will heal completely from scarring or existing HCV-related damage. There may still be a risk of HCV-related liver complications. Despite this, liver function normally improves post-SVR. However, if liver function tests are still abnormal, this group should be screened for other liver-related complications or conditions, such as iron overload, excessive alcohol use, or fatty liver disease.
Mental health, self-care, wellness
Post-SVR follow-up care may also include counseling for anxiety or depression. Self-care is also very important after SVR, as the person regains control of their life, relationships with loved ones, and previous hobbies. Due to liver scarring and other complications, The person can always get re-infected with HCV if engaging in high-risk behaviors. This is why follow-up care after SVR includes counseling aimed at cutting out risk factors as much as possible.