A guide to post-treatment care
By Andrew Reynolds @projectinform

After patients achieve a sustained virologic response (SVR) and are cured of HCV, the AASLD/IDSA/IAS-USA HCV Guidelines recommend the following:

If you have been cured with little to no fibrosis (F0 to F2), you should receive the same standard follow-up as if you never had HCV.

HCV recurrence is exceedingly rare, but re-infection can happen. If you do not have on-going risk for HCV (for example, injection drug use), you don’t need to screen for HCV routinely. If you do have risk, a known exposure to HCV, or an unexpected rise in your liver enzyme tests, you should screen for HCV using a quantitative HCV RNA test (viral load) rather than an HCV antibody test (you will always test positive for antibodies) to look for a new infection.

If you were cured after developing more advanced liver disease (F3 or F4), you should be screened for hepatocellular carcinoma (HCC, or liver cancer) with twice-yearly ultrasound testing.

If you were cured after developing cirrhosis, you should get an endoscopy to check for varices (enlarged veins in the torso, which can burst). If they should find varices, they will be treated appropriately and you will not likely have them again (it’s rare for them to return after getting cured).

Other important considerations:

Alcohol use: Without the virus, it is common to wonder if it’s safe to drink alcohol again. We know that alcohol, even drinking 1–2 glasses per day, accelerates HCV disease and increases risks of cirrhosis and other liver complications. But what about after someone has been cured? We don’t know: There is no research to help us make an informed recommendation on this subject. If you have cirrhosis, you cannot drink alcohol. For everyone else, it’s an important question to ask your medical provider, as she/he will know your liver health, the amount of fibrosis you have, and other complications that may help determine if you can or cannot drink alcohol.

HCV transmission and re-infection: Once you’re cured of HCV, you have no virus to transmit to others. This applies to sharing injection drug using equipment, sexual transmission, or other less risky forms of transmission such as sharing razors or toothbrushes. You can, however, get re-infected if you’re exposed to HCV again. If you use drugs, don’t share injecting equipment (anything: syringes, cookers, water, cotton, and so on), straws for snorting, or pipes for smoking. If you’re HIV-positive, be mindful of sexual transmission of HCV (HIV-negative people are at low risk of sexual transmission), and use condoms and other practices to minimize risk of blood exposure during sex.

Talk with your medical provider about any other important lab tests or follow-up that she or he recommends for your unique needs.

Should you have any other questions, call  (877) HELP-4-HEP, or (877) 435-7443, to speak with a trained HCV counselor/health educator.

—ANDREW REYNOLDS