What's the Post-Treatment Plan for cirrhotics who have achieved SVR?

[hepcandme]

I hear that some post-treatment people, like me, have lingering post-treatment sx but I don't see my docs with a plan for treating cirrhosis - just testing for HCV and liver tests?

BTW, I am feeling better - time is a good healer but I slayed the dragon and her baby dragons are still around - fatigue, aches, brain fog at times + portal hypertension and an enlarged spleen. None of which I am currently being treated for.

Have your docs said, OK, congrats on your SVR, this is where we stand now?

[flyinlynn]

Yes several people here have  Hepatic Encephalopathy (HE). Do you have a question about HE?

You could go to the top of the page and select the "Post a Question" link and ask away.

It is better to start your own thread so your question will get more notice than tagged on the end of someone else question

[bigbigjimzlll]

Is anyone suffering Hepatitus Encelapothy? I'm cured from Hep C Genome 1a for 6 moths now(Took the Harvoni) I've had no varices. I do have Portal Hypertention and an enlarged spleen where my platlet numbers are now up to the high 90's My liver is 80% fiberous. Low meld score of 12. The Hepatic encylopothy is my biggest struggle

[flyinlynn]

For me as I had grade 3 esophageal varicies that required banding back in 2012 at least for now I am having annual upper endoscopies to monitor for reoccurance. For colonoscopies I am having those done every 5 years which I believe is the normal schedule for over 50

[HectorSF]

For people who have varices monitoring should be continued if there is a danger of a future bleed.

*** Monitoring Patients Who Have Completed Treatment ***

"Bleeding from esophageal varices is rare after an SVR. 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."

Hector

[hepcandme]

Good answers, thanks. Is colonoscopy and endoscopy also part of follow up?

[slowolf]

My Hepatologist ordered endoscopy to check for varices (non found) and an abdominal CT scan to use as a baseline for future ultrasounds prior to treatment.  Part of the reasoning was my AFP levels were high. Post-treatment my AFP levels have normalized.  No indication of future endoscopy was given.  I also had a colonoscopy post treatment on recommendation of my PCP, everything normal there too. My Gastroenterolgist  recommended future colonoscopies at 10 years. My post treatment blood tests have been fairly normal except for low platelets due to my enlarged  spleen.

[slowolf]

Hector pretty much covered it in his response, but I'll add my take on it.

I reached 12 weeks SVR last month (Yay!)  I'm stage 4 with enlarged spleen, no varices and was instructed by my Hepatologist to have blood tests and abdominal ultrasound every six months. He stressed the importance of the ultrasound, to check for carcinoma, and said there was a small chance I could have liver failure over the next few years.

The plan for the cirrhosis at this point is to eliminate any other factors that can lead to further liver damage. I no longer drink alcohol  and haven't for years so that is no longer a factor. I am however, overweight and at risk for fatty liver. I was told that a diet contributing to fatty liver can be just as bad for your liver as drinking alcohol. To eliminate that factor, I was told to lose more weight (I have lost over 40 lbs in the past 2 years-currently 6'1" ,215 lbs), not eat starchy foods such as bread, rice, potatoes, sugary snacks, etc., avoid red meat,  and keep my daily sodium intake to less than 2 grams per day. The doctor also told me to eat mostly fresh fruits, beans, lentils, chicken and fish.

I feel so much better post-treatment and will continue to work on doing what I can to improve my liver health.  I have modified my diet at this point, and am working on losing even more weight. Whatever I can do to keep myself off the transplant list is my goal, and who knows, maybe a solution to reverse cirrhosis will be found someday!

[slowolf]

On edit to my post above, that should be fresh VEGETABLES, not fruit, although some fruits are OK.

[HectorSF]

Congrats on your SVR.

The only treatment for cirrhosis of the liver (or any stage of liver disease for that matter) is to treat the underlying cause of the liver injury to prevent further injury to the liver. This you have done by curing your chronic hepatitis C infection.

Unfortunately the damage that has already been done over the decades of infection remains. Typically it takes many years for the liver to repair itself after the ongoing damage has been stopped.

While there are no specific treatments for the complications of cirrhosis such as portal hypertension, portal hypertension as well as many other complications of cirrhosis, bleeding varices, ascites typically become no longer possible life-threatening complications after SVR in all but the very sickest patients with decompensated cirrhosis and these patients will continue to require a liver transplant to recover their health.

Now that more and more people for the first time in recent years are able to cure their hepatitis C with cirrhosis, in the next few years we should know much more about how the cirrhotic liver heals itself over time after SVR.

For all the latest and current medical information for the diagnosis, treatment and care for people who have or have had chronic hepatitis C we have The AASLD/IDSA  “HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C” available to all online.
http://hcvguidelines.org/full-report-view

Here are the latest recommendations for all providers for patients who have treated and cured their hepatitis C infection.
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*** Monitoring Patients Who Have Completed Treatment ***

Patients who have undetectable HCV RNA in the serum, when assessed by a sensitive polymerase chain reaction (PCR) assay, 12 or more weeks after completing treatment, are deemed to have achieved an SVR. In these patients, HCV-related liver injury stops, although the patients remain at risk for non–HCV-related liver disease, such as fatty liver disease or alcoholic liver disease. Patients with cirrhosis remain at risk for developing hepatocellular carcinoma.

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.

* 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.

*** 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.

* 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.

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

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).
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Remember to continue to have regular surveillance (ultrasound + AFP blood test) for hepatocellular carcinoma (HCC), ie liver cancer, as having had cirrhosis due to hepatitis C means you still have a increased risk of developing HCC despite being cured of the virus.

Hopefully as time goes on you will feel better and better.

Hector