Post-Treatment Care
By Andrew Reynolds @projectinform

A hepatitis C cure, also called a sustained virologic response (SVR), almost always results in improved liver health.

A concern that many people have after they’ve been cured is whether or not the virus is truly gone. Less than 1% of people cured of HCV experience a return of the virus, so an SVR is a true cure. You will still have HCV antibodies, for which you will always test positive, but that does not mean you are still infected, because there is no virus to potentially damage your liver. People also often wonder about the risk of infecting others: With no virus, there’s nothing to transmit. Antibodies are not infectious.

Following your cure, the AASLD/IDSA HCV Guidelines recommend the following:

  • If you’ve been cured with little to no fibrosis (F0-F2), you should receive the same standard of care as if you never had HCV.
  • Although HCV recurrence following cure is exceedingly rare, reinfection of HCV can happen. If you don’t have ongoing risk for HCV (for example, injection drug use), you don’t need to screen for HCV routinely. If you do still 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 to detect reinfection.
  • If you’ve been cured after developing more advanced liver disease (F3 or F4), you should be screened for hepatocellular carcinoma (HCC or liver cancer) with twice-yearly ultrasounds (every 6 months).
  • If you’ve been cured after developing cirrhosis, you should get an endoscopy to check for varices (enlarged veins in the torso, which can burst). If varices are found, they will be treated appropriately and you will not likely get them again (it’s rare for them to return after getting cured).

Other Important Considerations

Alcohol use: Without the virus, it’s common to wonder if it’s safe to drink alcohol again. We know that alcohol, even drinking just 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 has not been any research to help us make an informed recommendation on this subject. If you have cirrhosis, you cannot drink alcohol safely. If you have more moderate levels of fibrosis you should speak with your medical provider as she/he knows your liver health and other potential complications that may help you determine if you can or cannot drink alcohol.

HCV reinfection: Once cured, you’ll have HCV antibodies but they don’t necessarily offer protection from reinfection. If you use drugs, don’t share injecting equipment (syringes, cookers, cotton filters, water, etc.), straws for snorting, or pipes from smoking. If you’re HIV-positive, be mindful of sexual transmission of HCV, and use condoms and other practices to minimize risk of blood exposure during sex. Screen for HCV at least once a year, but you might want to do it more frequently to catch HCV reinfection as quickly as possible.

Cirrhosis and fibrosis: These two conditions may reverse after a cure. Yes, your liver may return to normal.

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

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

 Tips for healthy living with cirrhosis

With these and any other tips, talk with your medical provider about the best things you can do to live as healthy as you can with cirrhosis.

  • Keep all medical appointments with your provider.
  • Take all medications as prescribed.
  • Don’t take any medications—prescription or over-the-counter—without consulting your medical provider.
  • Get vaccinated against pneumonia and your annual flu shot, as people with cirrhosis are vulnerable to infections.
  • Maintain healthy bowel movements as constipation can lead to more toxins in the body. You may need to take medications to help with this.
  • Do not take Tylenol as that can be damaging to an already damaged liver. Check the labels of medications as acetaminophen, the active ingredient in Tylenol, can be found in many over-the-counter and prescribed medications.
  • Eat a well-balanced diet that’s low in fat and has a proper amount of protein. Too much animal protein can lead to encephalopathy (mental confusion). A vegetarian diet may be a better option.
  • Cut down on, if not eliminate, salt (sodium). Salt can lead to water retention, mess with your blood pressure, and increase the risk of developing ascites.
  • Drink coffee. Coffee appears to have many health benefits, including slowing cirrhosis and reducing risk of developing liver cancer.