Follow-Up Care After SVR

What is recommended for HCV treatment follow-up after achieving SVR?

Currently, the strongest indicator of a successful treatment regimen is achieving sustained virologic response (SVR), or undetectable levels of HCV virus in the blood. SVR is detected via tests that measure the quantitative levels of HCV RNA after completing a course of treatment. SVR can be managed during treatment, however, testing for and achieving SVR at 12 weeks post-treatment (SVR12) is considered the main indicator of treatment success by the American Association for the Study of Liver Diseases and the Infectious Disease Society of America. SVR12 is generally associated with a long-term cure of HCV infection as well as a long-term reduction in liver-related conditions related to HCV. Other organizations, like the World Health Organization (WHO) cite SVR at 24 weeks (SVR24) as the main indicator of treatment success.1

After treatment, there are three main categories of individuals. These include those who have completed treatment and achieved SVR12, those who have completed treatment but did not achieve SVR, and those who did not complete treatment due to adverse side effects and other issues. Achieving SVR by way of interferon-based treatments or DAA-based treatments is associated with a 97% or greater chance of maintaining undetectable HCV RNA levels across long-term follow-up periods, which typically range for about 5 years.2 There are different guidelines for follow-up plans based on the risk of developing reinfection, and the presence or extent of fibrosis or cirrhosis of the liver. These groups include:2, 3

Achieved SVR12 and have normal liver function test results and no fibrosis:

Individuals who fall into this category should be treated as if they never had HCV. Depending on the preference of the provider seen, there may be additional blood tests for HCV RNA levels at 6 or 12 months post-treatment, to ensure longer-term SVR.

Achieved SVR12 and have mild fibrosis (F1-F2 fibrosis):

The individuals in this category have minimal scarring or scarring that has extended to other areas outside of the liver that contain blood vessels. Current guidelines recommend that these individuals do not receive additional monitoring for HCV or liver conditions. Typically, these individuals do not have any further HCV-related liver issues. They can be treated in a similar manner as those with no fibrosis and normal liver function test results.

Achieved SVR12 and have advanced fibrosis or cirrhosis (F3-F4 fibrosis/cirrhosis):

These individuals have bridging fibrosis that is connecting to other fibrosis-containing areas, or cirrhosis of the liver. The risk of HCV-related liver issues is reduced greater than before SVR12, however, it is recommended that these individuals undergo regular ultrasound screenings of their liver approximately every 6 months to monitor for any liver conditions such as liver cancer. Additionally, individuals with SVR12 and cirrhosis should be screened for varices if they haven’t been screened already. Varices are enlarged veins in the esophagus (the tube connecting the mouth and stomach) that develop as a result of poor blood flow to the liver after a clot or scarring. Smaller vessels will take on additional blood flow when varices develop, and may rupture or leak causing bleeding.

Achieved SVR12 and have an ongoing risk of HCV (regardless of fibrosis or cirrhosis):

Individuals in this category need regular screenings for HCV RNA to detect reinfection. Other tests to monitor liver enzymes can also be completed. These individuals may also receive counseling on the prevention of HCV reinfection and other additional 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, and there may still be a risk of HCV-related liver complications. Despite this, liver function should typically improve 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 or fatty liver disease, as well as evaluated for excessive alcohol usage.

Post-SVR follow-up care may also include counseling for any HCV-related conditions such as anxiety or depression. Self-care is also very important post-SVR, as individuals who previously suffered from HCV regain control of their life, relationships with loved ones, and previous hobbies. Regardless of time since SVR12, liver scarring, and other complications, an individual can always get re-infected with HCV if they are engaging in risky behaviors, which is why follow-up care post-SVR also includes cutting out these risk factors as much as possible.

Written by: Casey Hribar | Last reviewed: August 2017.
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