Follow-Up Care After SVR

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

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, and the patient is “cured.”1,2

SVR is measured in a test that looks for levels of HCV RNA in the blood. This test is given after a person finishes treatment. The doctor may track HCV RNA levels in the middle of treatment, but someone with hepatitis C is not considered cured until weeks later.1,2

Achieving SVR 12 weeks after treatment (also known as SVR-12) is the main sign that the treatment has worked, according to the American Association for the Study of Liver Diseases and the Infectious Disease Society of America. SVR means the body is rid of HCV infection.1,2

What happens after achieving SVR?

The chance of the virus being detected again after SVR, without reinfection, is very low. This type of relapse happens in less than 1 percent of people who have successfully completed treatment. Also, after reaching SVR, you cannot infect others with hepatitis C.3

Follow-up plans after SVR depend on the risk of reinfection and the presence of liver damage.

Normal liver function

After achieving SVR, people with no liver scarring and normal liver function will usually 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.2,3

Like anyone, people in this group can have or develop liver damage unrelated to HCV. For example, liver damage can come from heavy drinking or fatty liver disease. In this case, a doctor may monitor liver health after HCV treatment.2

Does reaching SVR cure liver damage?

Achieving SVR does not mean that the liver will heal completely from scarring or existing HCV-related damage. This scarring is sometimes called cirrhosis or fibrosis. In this case, there may still be a risk of HCV-related liver complications. Despite this, liver function normally improves after SVR is achieved.3

It is recommended that people with liver damage get an endoscopy every 2 to 3 years, depending on the damage. An endoscopy is a procedure used to look inside the upper gastrointestinal system. In an endoscopy, a doctor uses a small, long, and flexible camera to check your esophagus.3

The goal of the endoscopy is to look for varices. 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.3

People with liver damage after achieving SVR are also at an increased risk of liver cancer. It is recommended they get an ultrasound every 6 months to check for signs of cancer.3

Ongoing risk of HCV

Some people remain at risk for hep C reinfection after achieving SVR. The increased risk is usually due to participating in higher-risk behaviors such as using injection drugs. For this group, annual screenings for HCV reinfection are recommended. People in this group may also need counseling on the prevention of HCV reinfection and other support to minimize higher-risk behaviors.3

Mental health, self-care, and wellness

Post-SVR follow-up care may also include counseling for anxiety or depression, which are common in people with hepatitis C. Someone can always get re-infected with HCV if they engage in higher-risk behaviors. Also, existing liver scarring and other complications may put them at higher risk of reinfection. This is why follow-up care after SVR includes counseling aimed at cutting out risk factors as much as possible.

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