2017-03-31 15:14:53 UTC

Hepatitis C Virus (HCV) 106: Managing Hepatitis C After Sustained Virologic Response (SVR)

Learn more about Sustained Virologic Response (SVR) in this patient companion, based on the AGA Clinical Practice Update "Care of Patients Who Have Achieved Sustained Virologic Response (SVR) Following Antiviral Therapy for Chronic Hepatitis C Infection."

Clinical Practice Updates are developed under the guidance of the AGA Institute Clinical Practice Updates Committee and provide best practice advice on cutting-edge topics in the practice of gastroenterology and hepatology. The Clinical Practice Updates are based on a combination of a review of the current scientific literature and expert opinion to help guide gastroenterologists and other health-care professionals at the point of care. The below information presents important content from AGA Clinical Practice Updates in a way that will help patients better understand AGA’s best practice advice on these new, hot-button topics.

AGA Clinical Practice Update: Care of Patients Who Have Achieved Sustained Virologic Response (SVR) Following Antiviral Therapy for Chronic Hepatitis C Infection

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.



What is Sustained Virologic Response (SVR)?
Getting Checked for Relapse 
Getting Checked for HCC
Getting Checked for Varices
Staying Healthy After SVR


What is Sustained Virologic Response (SVR)?

  • Lately, new drugs have been made available that strongly reduce the amount of Hepatitis C virus (HCV) in a patient’s body. These drugs are called direct-acting antivirals, or DAAs. 
  • In 90% of patients, DAAs are thought to be a cure for HCV. This is because they lead to a sustained virological response (or SVR for short), which means that no virus is found in the blood for over 12 weeks. 
    • Most patients who take DAAs become virus-free within 12 weeks.
    • More than 99 percent of patients who reach SVR will never have HCV infection come back.
  • However, even after reaching SVR, some patients are still at risk for serious health conditions linked to HCV infection, such as:
    • Cirrhosis (scarring of the liver tissue)
    • Liver failure
    • Hepatocellular carcinoma (HCC; a type of liver cancer linked to hepatitis)
  • These health issues can be caused by the harm that was done to the liver while the person was still had HCV infection. They may also be made worse if relapse or reinfection happens, or if other things, such as drinking too much alcohol, lead to further harm to the liver.
  • If left untreated, these health problems can be deadly.


Getting Checked for Relapse

  • Because of the dangers tied to long-term HCV infection, your doctor should re-test your blood after ending treatment to make sure you are still clear of the virus.
    • According to the American Gastroenterological Association, this check-up should happen at 3 months and within 6 – 12 months after ending DAA treatment.
    • Based on certain factors, your doctor may also want to re-check your blood after the one-year mark. 
      • It will be checked more often if you have a higher chance of being reinfected with HCV.
      • Talk to your doctor about your risk factors and how to reduce the chances of getting reinfected.


Getting Checked for HCC

  • Hepatocellular carcinoma, or HCC for short, is a type of liver cancer than can be caused by long-term HCV infection. 
    • Patients who have major liver scarring (also called stage 3 fibrosis) or cirrhosis (stage 4 fibrosis) are at higher risk for HCC.
  • If you have stage 3 or 4 fibrosis caused by HCV, your doctor may decide to test you twice a year for HCC.
    • Whether your doctor tests you for HCC depends on how much cirrhosis you have.


Getting Checked for Varices

  • Varices are swollen veins that can break open and cause serious bleeding inside of the gut. 
    • Long-term HCV infection can cause varices to grow in the esophagus or stomach.
  • All patients who have cirrhosis should be checked for varices right away after finishing DAA treatment. This screening is done by endoscopy. 
    • In an endoscopy, the doctor takes a thin, flexible tube with a camera on the end and places it down the throat. This lets the doctor view inside to check for varices.
  • If your doctor finds no varices, or if the varices are small, your doctor should wait 2-3 years to do another endoscopy.
    • During this second check-up, your doctor will make sure that there are still no varices, or that none of the small varices have grown in size.
    • If the doctor sees no varices during the second check-up and you are not at risk for worsening of cirrhosis, your doctor may decide not to do any more tests.
  • If your doctor finds any larger varices, you may be treated with drugs or with a simple procedure called a band ligation.
    • In a band ligation, your doctor will use the endoscope to tie small rubber bands onto the varices so that they cannot bleed. The varices will peel off and heal within a few days.
    • After all the varices have been treated, your doctor should follow up with another endoscopy within 6-12 months, and again 1-2 years later.


Staying Healthy After SVR

  • Even when no more Hepatitis C Virus can be found in your blood, you may be at a higher risk for cirrhosis, liver failure, or HCC over the course of your lifetime.
  • The best way to prevent health problems after reaching SVR is to lead a healthy life. This includes:
    • Greatly lowering or stopping alcohol use.
    • Staying at a healthy weight by getting regular exercise and eating a diet with a variety of fruits, vegetables, and whole grains. This is because being obese (having a high amount of body fat) can cause severe liver disease.
  • Talk to your doctor about ways you can lead a healthier lifestyle to prevent liver-related health problems.


©AGA, July 2016

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