Long-term follow-up after cure

Long-term follow-up after cure of hepatitis C is required in patients with persisting liver pathology and those at risk of reinfection. Recommendations are shown in Long-term follow-up of patients cured after hepatitis C treatment.

In patients with cirrhosis, 6-monthly surveillance for hepatocellular carcinoma should be continued long term, even if hepatitis C is cured. Ongoing monitoring for oesophageal varices and osteoporosis is also recommended in these patients.

Table 1. Long-term follow-up of patients cured after hepatitis C treatment

[NB1]

Patient characteristics

Recommended follow-up

Patients with cirrhosis

Refer to specialist for review.

Patients with cirrhosis require long-term monitoring for:

Patients with abnormal liver biochemistry, defined as:

males: ALT = 30 units/L or more

females: ALT = 19 units/L or more

Evaluate for other causes of liver disease.

Refer to specialist for review.

Patients with risk factors for hepatitis C reinfection (see Risk factors for hepatitis C infection)

Offer an annual HCV RNA test to check for reinfection.

Offer harm reduction strategies.

Offer retreatment if a person becomes reinfected.

Patients in whom all of the following apply:

  • no cirrhosis
  • normal liver biochemistry (males: ALT less than 30 units/L; females: ALT less than 19 units/L)
  • no risk factors for hepatitis C reinfection (see Risk factors for hepatitis C infection)
  • no evidence of any other chronic liver disease (eg nonalcoholic fatty liver disease)

No clinical follow-up for hepatitis C or liver disease required.

Note:

ALT = alanine aminotransferase; HCV = hepatitis C virus

NB1: Cure of hepatitis C (sustained virological response [SVR]) is defined as undetectable HCV RNA in blood at least 12 weeks after completion of treatment.