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Post SVR Care and Follow-Up: Why, When and How?

Post SVR Care and Follow-Up: Why, When and How?

21 Aug 2021 10:44 10:56
(12 mins)
Lim Seng-Gee Speaker
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HCV SVR is now almost universal in all treated patients. The outcomes after SVR may be either improved, worsened or unchanged. The likelihood of having improved outcomes is related to the extent of liver fibrosis. Those without F3/4 fibrosis have the most benefit but those with cirrhosis still have a risk of HCC and decompensation particularly if they have advanced fibrosis with decompensation or clinically significant portal hypertension. In these groups there is no improvement in clinical event-free survival, HCC-free survival or Liver Transplant-free survival. We can use liver stiffness measurements (LSM) to assess baseline fibrosis, and those with LSM<10kpa have very low risk of events. However caution in the case of diabetes and there is still a possibility of liver events and HCC post-SVR. Regression of fibrosis can occur post-SVR in as many as 78% one year after SVR, with baseline fibrosis, BMI and steatosis as risk factors. Post SVR the reinfection rate is very low but higher in PWID. Extrahepatic events, esp cardiometabolic events are reduced after SVR but they still may be contributors to mortality post SVR. In conclusion, for HCV post SVR followup, those who should be followed are those with significant fibrosis, decompensation and metabolic syndrome (Who), as these patients run a higher risk of HCC and liver decompensation (why) and they should be followed 6monthly with ultrasound ± AFP (How); LSM is optional.

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