Successful viral eradication (cure) is defined as undetectable plasma or whole-blood HCV RNA using a highly sensitive PCR assay at least 12 weeks after completion of DAA therapy (SVR12). Late relapse after SVR is very uncommon (< 0.5%), and the reappearance of HCV after this time point is most frequently due to reinfection. Recent data suggest there is a very high correlation between SVR4 (undetectable plasma or whole-blood HCV RNA using a highly sensitive PCR assay 4 weeks after completion of DAA therapy) and SVR12. [64.65] Therefore, opportunistic testing of HCV RNA at any time beyond 4 weeks after treatment completion is adequate, especially when there is concern about subsequent loss to follow-up (e.g. in prisoners for whom release to the community may be imminent).
People who do not have cirrhosis and who have normal liver function test results after SVR (male, ALT ≤ 30 U/L; female, ALT ≤ 19 U/L) have no further need of specialist liver services and can be medically managed as if they never had HCV infection. There is no reason to repeat anti-HCV serological tests. It should be reiterated to all people who have achieved SVR that persistence of anti-HCV antibodies is expected and that this does not represent active infection, nor does it confer immunity to reinfection. The medical records of patients for whom SVR is confirmed should be amended to reflect that they are no longer living with hepatitis C.
Those who fail to achieve SVR should be assessed for explanations for treatment failure (especially adherence, drug resistance and reinfection). Retreatment should be considered as appropriate. In this setting, referral to an expert treatment centre is advisable.
People with ongoing risk factors for the transmission of HCV infection should have at least annual HCV RNA testing performed. As noted, anti-HCV antibodies will remain positive in all people with prior exposure, and this does not require repeated testing.