post hep c tests

[trapper]

june 2015 was 12 post hcv test witch was good.  hcv gone.  how long after do they want you to get a scan or biopsy to ck  liver for cancer or whatever and whats the best test to get.  I was f-3 prior to treatment. thanks  trapper

[gnatcatcher]

Every doctor seems to have a different idea of when, what, and how often to test. My hepatologist was going to do an SVR36 rather than an SVR24, but since my PCP would be doing labs at around the SVR24 date, the hepatologist decided just to have my PCP test my viral load then. Then he wants an annual viral load (plus a hepatic panel, which my PCP does annually anyway) for 3 years. If my next FibroScan (in late June) still shows F4, the hepatologist wants me to keep having ultrasounds and hepatology follow-ups every six months. If I revert to F3, he's going to let my PCP handle things from then on out.

Congratulations on eradicating the HCV. Please let us know what further tests your doctor orders.

Gnatty

[Lynn K]

For me as a F4 cirrhosis patient I am to have Abdominal ultrasound and Alpha fetoprotein (AFP) blood testing every 6 months to monitor for possible HCC I will likely have this done for life.

I will also have annual upper endoscopies to check for recurrence of esophageal varicies. I developed grade 3 varicies the required banding back in 2012 so I am checked to make sure they don't come back.

I am having my one year follow up soon post treatment and asked to do a HCV RNA by PCR test for my own peace of mind. I doubt I will do any more testing for the virus after that.

I found this on the AASLD (American Association for the Study of Liver Disease) web site.

http://www.hcvguidelines.org/full-report/monitoring-box-summary-recommendations-monitoring-patients-who-are-starting-hcv

HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

Summary of the Recommendations for Monitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy

Recommended follow-up for patients who achieve a sustained virologic response (SVR).

For patients who do not have advanced fibrosis (ie, those with Metavir stage F0-F2), recommended follow-up is the same as if they were never infected with HCV.

Rating: Class I, Level B

Assessment for HCV recurrence or reinfection is recommended only if the patient has ongoing risk for HCV infection or otherwise unexplained hepatic dysfunction develops. In such cases, a quantitative HCV RNA assay rather than an anti-HCV serology test is recommended to test for HCV recurrence or reinfection.

Rating: Class I, Level A

Surveillance for hepatocellular carcinoma with twice-yearly ultrasound testing is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR.

Rating: Class I, Level C

A baseline endoscopy is recommended to screen for varices if cirrhosis is present. Patients in whom varices are found should be treated and followed up as indicated.

Rating: Class I, Level C

Assessment of other causes of liver disease is recommended for patients who develop persistently abnormal liver tests after achieving an SVR.


In more detail

With the advent of highly effective HCV antiviral regimens, the likelihood of achieving an SVR among adherent, immunologically competent, treatment-naive patients with compensated liver disease generally exceeds 90%. Of patients who achieved an SVR with PEG-IFN  and RBV treatment, more than 99% have remained free of HCV infection when followed up for 5 years after completing treatment. (Manns, 2013) Thus, achieving an SVR is considered a virologic cure of HCV infection.

SVR typically aborts progression of liver injury with regression of liver fibrosis in most but not all treated patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Because of lack of progression, patients without advanced liver fibrosis (ie, Metavir stage F0-F2) who achieve an SVR should receive standard medical care that is recommended for patients who were never infected with HCV.

Among patients with advanced liver fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR, decompensated liver disease (with the exception of hepatocellular carcinoma) rarely develops during follow-up, and overall survival is prolonged. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients who have advanced fibrosis or cirrhosis continue to be at risk for development of hepatocellular carcinoma after achieving an SVR, although the risk in these patients is lower than the risk in persistently viremic patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis who achieve SVR experience increased survival (compared with patients with cirrhosis who are untreated or in whom treatment fails), but still may be at some risk for hepatocellular carcinoma; thus, they should continue to undergo regular surveillance for hepatocellular carcinoma despite the lowered risk that results after viral eradication. (Bruix, 2011) The risk of hepatocellular carcinoma among patients with advanced fibrosis prior to treatment but who have regression to minimal fibrosis after treatment is not known. In the absence of data to the contrary, such patients remain at some risk for hepatocellular carcinoma and should be monitored at regular intervals for hepatocellular carcinoma.

Liver fibrosis and liver function test results improve in most patients who achieve an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Bleeding from esophageal varices is rare after an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis should receive routine surveillance endoscopy for detection of esophageal varices if not previously done and these should be treated or followed up as indicated. (Garcia-Tsao, 2007)

Patients in whom an SVR is achieved but who have another potential cause of liver disease (eg, excessive alcohol use, metabolic syndrome with or without proven fatty liver disease, or iron overload) remain at risk for progression of fibrosis. It is recommended that such patients be educated about the risk of liver disease and monitored for liver disease progression with periodic physical examinations, blood tests, and potentially, tests of liver fibrosis by a liver disease specialist.

Periodically testing patients with ongoing risk for HCV infection (eg, illicit drug use, high-risk sexual exposure) for HCV reinfection is recommended. Flares in liver enzyme test results should prompt evaluation of possible de novo reinfection with HCV through a new exposure (see Management of Acute HCV Infection). Antibody to HCV (anti-HCV) remains positive in most patients following an SVR. Thus, testing for reinfection with HCV is recommended and should be performed with an assay that detects HCV RNA (eg, a quantitative HCV RNA test).

[trapper]

thanks knatty and lynn.  the info answers my questions. thanks   trapper