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Hepatitis C after sustained virological response — ESEGH MCQ

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ModerateHepatologyHepatitis C after sustained virological responseESEGH

A 31-year-old man is reviewed after completing direct-acting antiviral therapy for genotype 1 hepatitis C. Before treatment he had established cirrhosis, with a platelet count of 82 × 10^9/L. He remains clinically compensated and has undetectable HCV RNA 12 weeks after completing treatment. What is the most appropriate approach to hepatocellular carcinoma surveillance?

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Correct answer: B — Continue liver ultrasound surveillance every 6 months

The correct answer is B. SVR12 confirms virological cure, but it does not abolish hepatocellular carcinoma risk in a patient who had established cirrhosis before treatment. He should therefore remain in 6-monthly ultrasound surveillance. His marked thrombocytopenia also supports clinically significant portal hypertension and reinforces that this was advanced liver disease rather than mild fibrosis. Surveillance should not be stopped or reduced to annual imaging solely because SVR has been achieved. Alpha-fetoprotein alone is insufficient as a surveillance strategy. Routine serial HCV RNA testing is used to assess suspected reinfection in patients with ongoing exposure risk and does not replace HCC surveillance.

Reference: European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: Final update of the series, section 'Follow-up of patients who achieved an SVR', 2020. https://easl.eu/wp-content/uploads/2020/10/EASL-recommendations-on-treatment-of-hepatitis-C.pdf