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Post-SVR Decompensation Investigation — SCE Infectious Diseases MCQ

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ModerateHepatitisPost-SVR Decompensation InvestigationSCE Infectious Diseases

A 50-year-old man with chronic HCV cirrhosis treated with DAAs achieves SVR12. Two years later, he develops hepatic decompensation (ascites, jaundice). HCV RNA is undetectable confirming sustained cure. What should be investigated?

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Correct answer: E — Exclude other causes of decompensation: alcohol, NAFLD/NASH, autoimmune hepatitis, drug-induced liver injury, portal vein thrombosis, HCC — SVR does not reverse established cirrhosis in all patients; decompensation can occur from cirrhosis progression despite viral cure

Post-SVR decompensation occurs because SVR reduces but does not eliminate cirrhosis complications. Established cirrhosis may continue to progress from: (1) ongoing cofactors (alcohol, NAFLD — very common), (2) portal hypertension already established before SVR, (3) HCC development. Investigation: liver USS for HCC, portal vein Doppler for PVT, autoimmune markers, alcohol assessment, metabolic syndrome assessment. This case emphasises that achieving SVR does NOT mean the patient is 'cured' of liver disease — lifelong cirrhosis monitoring is needed.

Reference: EASL 2024 – Post-SVR; NICE NG50 – Cirrhosis