Thursday, January 17, 2019

After The Cure: What’s Next? Hepatitis C Post-Treatment Management

Listen to experts discuss important HCV related topics in the following easy to access webinar series provided by HepCure.

Achieved SVR, What’s Next? HCV Post-Treatment Management
This month Dr. Anthony Martinez of University at Buffalo presented; Achieved SVR, What’s Next? HCV Post-Treatment Management. 

Topics Discussed
1. Define sustained virologic response (SVR).
2. Describe how to manage cirrhotic patients post-SVR
3. Discuss at-risk populations for HCV reinfection

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Recommended Reading 
AASLD-IDSA Hepatitis C Guidance:
Monitoring Patients Who Are Starting HCV Treatment, Are on Treatment, or Have Completed Therapy
Post-Treatment Follow-Up for Patients Who Achieved a Sustained Virologic Response
Patients who have undetectable HCV RNA in the serum, as assessed by a sensitive polymerase chain reaction (PCR) assay, ≥12 weeks after treatment completion are deemed to have achieved SVR. In these patients, HCV-related liver injury stops, although they remain at risk for non-HCV–related liver disease, such as fatty liver disease or alcoholic liver disease. Patients with cirrhosis or advanced fibrosis remain at risk for developing hepatocellular carcinoma (HCC).
Continue reading...….

May 2017 Gastroenterology
American Gastroenterological Association Institute Clinical Practice Update—Expert Review: Care of Patients Who Have Achieved a Sustained Virologic Response After Antiviral Therapy for Chronic Hepatitis C Infection
Ira M. Jacobson, Joseph K. Lim, Michael W. Fried

Full-text - Download PDF

Background and Objective
With the advent of safe and highly effective DAAs, cure of HCV infection has become more frequent. On the basis of randomized and observational studies, systematic reviews, and expert opinion, the authors of this clinical practice update present key recommendations about whether, when, and how long HCV patients who have achieved SVR should receive ongoing liver care.

Key Points
Confirm long-term virologic response at 48 weeks posttreatment. This recommendation is based on clinical trial results that have identified a late-relapse rate of ±0.5%. However, further confirmation of virologic response beyond 48 weeks posttreatment is not supported by the available evidence.

For patients with stage 3 fibrosis or liver cirrhosis, continue post-SVR surveillance for hepatocellular carcinoma (HCC) for an indefinite period of time, since research has identified no point beyond which the risk for HCC is reduced to that of patients without liver disease. For patients with earlier stages of fibrosis, no surveillance is recommended.

Continue endoscopic screening for varices in all patients with cirrhosis (whether or not they have SVR). However, in patients with SVR who are not at risk for progressive liver disease, if no varices are identified within 2 to 3 years, cessation of further surveillance may be considered.

Noninvasive methods can be used to assess progression and regression of fibrosis after SVR. However, do not alter HCC surveillance protocols in patients with baseline cirrhosis, even when regression of fibrosis is noted, since fibrosis regression assessed by noninvasive testing has not been shown to accurately indicate a reduction in HCC risk.

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