Monitoring
Quantitative HCV RNA and LFTs are performed 4 weeks after treatment completion and 12 weeks later to confirm undetectable HCV RNA (SVR) and transaminase normalization. For patients who achieved SVR, monitor for HCV recurrence. No liver-related follow-up is needed for those without cirrhosis who achieved SVR. Patients with ongoing risk for HCV infection should be counseled about risk reduction and tested for HCV RNA yearly and whenever they develop elevated ALT, AST or bilirubin. Patients failing to achieve SVR following initial antiviral therapy should be evaluated for retreatment. For patients awaiting retreatment, assess for disease progression every 6-12 months with LFTs, CBC, and INR. Hepatocellular carcinoma is screened using ultrasound surveillance with or without AFP testing every 6 months.
Prognosis
Consequences of Hepatitis C Virus Infection
Approximately 55-85% of patients who acquire acute hepatitis C will
remain HCV infected. Of these patients, 5-20% may develop
cirrhosis over the next 20-25 years. HCV-related cirrhosis is
associated with the risk of developing end-stage liver disease (30% risk over
10 years) as well as hepatocellular carcinoma. In patients with persistent
infection, the evolution to cirrhosis is the primary concern. This usually
occurs ≥20 years after initial infection and occurs more often in patients at
older ages (especially men), those who drink >50 g of alcohol/day, those who
are obese or have substantial hepatic steatosis and those with HIV infection.