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Post-SVR Cirrhosis Complications — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyPost-SVR Cirrhosis ComplicationsRACP Adult Medicine

A 60-year-old woman with hepatitis C-related cirrhosis achieves SVR with DAA therapy. She now has no detectable HCV RNA. Despite SVR, she develops ascites and variceal bleeding 2 years later. What is the explanation?

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Correct answer: A — SVR does not reverse established cirrhosis – portal hypertension persists

SVR (cure of HCV) halts ongoing liver injury and may lead to partial fibrosis regression, but established cirrhosis (particularly with significant portal hypertension) often persists. Complications of portal hypertension (ascites, variceal bleeding, HCC) can continue to develop even after SVR. This is why ongoing surveillance (6-monthly HCC screening, endoscopic variceal screening) is mandatory in all patients with established cirrhosis regardless of SVR status. The rate of decompensation is reduced but not eliminated by SVR.

Reference: Gastroenterological Society of Australia – 2022 – HCV Consensus; AASLD – 2023