Hep C Discussion Forum

Excerpt of opinion from a well-known American liver doc - he portrays a further "case" situ, but I highlight only the nucleus of his rationale in how he follows his hepc pts.:

PS - I have always appreciated this particular docs careful approach to certain issues, for example how he handles core positive only hepb pts. Nice, when you can't be too careful how you screen and follow your hepc pts.!  : ) 

" ... For patients who have achieved cure, our emphasis must shift from eradicating viral disease to managing liver disease. The complications of advanced fibrosis and cirrhosis are reduced following SVR but do not disappear completely. In particular, we must be aware of the persistent elevated risk for HCC in patients with cirrhosis or F3 fibrosis.

Data from the interferon treatment era and, more recently, from the current direct-acting antiviral era demonstrate that patients with HCV infection are at risk for developing HCC and that achievement of SVR reduces this risk - in both cirrhotic and noncirrhotic patients - by approximately 70%, although the absolute risk of development of HCC in those without cirrhosis is substantially lower than in those with cirrhosis. Both the AASLD/IDSA and EASL guidelines recommend that patients with F3-F4 fibrosis be monitored for HCC by ultrasonography every 6 months following achievement of SVR. Until further data are generated, this HCC screening should continue indefinitely. I would recommend screening the case patient in this way, as he had F3 fibrosis prior to direct-acting antiviral therapy.

 ... we are now doing fewer liver biopsies to stage fibrosis, instead relying on elastography and serum markers of fibrosis. It is hoped that with additional risk stratification models and improved biomarkers, we will be able to better identify those at highest risk for developing HCC, allowing screening to be fine-tuned to target populations most likely to develop HCC. For now, all patients who are evaluated for hepatitis C and determined to have F3 or F4 fibrosis should be screened twice annually with ultrasound following SVR, regardless of how fibrosis was assessed ... "