Today’s HCV medications cure nearly everyone: People living with HCV who are in overall good health are cured over 95% of the time. Even those who aren’t cured the first time can get cured at very high rates using different medications. Once cured, the virus won’t bounce back: Less than 1% of people cured experience a return of the virus, so a sustained virolgic response (SVR) is a true cure. That said, you’ll still want to monitor your liver health and prevent the risk of getting re-infected with HCV.
Once you’re cured, HCV-related liver disease progression almost always stops, even in those who have cirrhosis.
Liver health post-cure
Following your cure, AASLD/IDSA HCV Guidelines recommend the following:
People who have no cirrhosis:
• 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. You won’t have to worry about your liver health any more than would someone who has never had HCV.
• Although HCV recurrence following cure is exceedingly rare, HCV re-infection 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 experience 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 re-infection.
• If you have an unexpected flare-up in your liver enzymes after cure, your medical provider may order an HCV test to rule out re-infection while looking for other causes.
People who have cirrhosis:
Curing HCV, even when people have cirrhosis, leads to improved liver health. Risk of liver failure, liver cancer, and liver-related death drop dramatically for many people after they’ve been cured. If you have cirrhosis, especially decompensated cirrhosis, you will still want to monitor your liver health as follows:
• 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 ultrasounds twice-yearly (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 can be treated appropriately and you will not likely get them again (it’s rare for them to return after getting cured).
• If your liver function tests are consistently elevated and abnormal, your medical provider will assess you for other causes of liver disease.
Other important considerations
Alcohol use: Without the virus, it’s common to wonder if it’s safe to drink alcohol again. Alcohol, even drinking just 1–2 glasses per day, accelerates HCV disease and increases risk 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 make an informed recommendation. If you have cirrhosis, you cannot drink alcohol safely. If you have more moderate levels of fibrosis you should talk with your medical providers; they know your liver health and other potential complications that may help you determine whether you can drink alcohol.
Hepatitis B reactivation: If you were deemed at risk for HBV reactivation before starting HCV treatment, you should continue to stay in touch with your medical provider to monitor your liver health. If you are on HBV treatment, you may have to continue treatment for 3 months following completion of HCV DAA therapy. Do not stop taking HBV medication without consulting your provider. For more information about HBV reactivation, check out page 34.
HCV re-infection: If you use drugs, don’t share injection 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 that 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 detect HCV re-infection as quickly as possible. For tips on reducing your risk for HCV re-infection, check out “Hepatitis C Prevention for People Who Inject Drugs” and “Hepatitis C Awareness for Gay Men.”
Fibrosis and cirrhosis: These two conditions may reverse over time following a cure. Yes, your liver may return to normal. For more information, check out “Your Liver and Hepatitis.”