Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals

Treatment of hepatitis C (HCV) has been revolutionized with the introduction of direct-acting antivirals (DAAs). Patients can be treated at more advanced stages of liver disease, with a growing number of cirrhotic patients achieving sustained virological response (SVR). Long-term outcomes for cured patients and the optimal follow-up care of patients after SVR are yet to be defined, because most studies on cirrhotic patients cured with DAAs have a short follow-up period. There are many open questions related to patient management after viral eradication with DAAs, such as which could be the most reliable non-invasive tool to predict liver-related complications, or to what extent viral eradication reduces the risk of liver disease progression in the long term. Growing evidence supports the personalization of follow-up care based on individual risk. The aim of this narrative review is to analyze the impact of viral eradication with DAAs on clinically significant portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as to summarize indications for optimal follow-up care of HCV patients treated with DAAs.

Automated summary

The treatment of hepatitis C (HCV) has been revolutionized by the use of direct-acting antiviral drugs (DAAs), allowing for treatment in advanced stages of liver disease. However, the long-term outcomes and optimal follow-up care for patients after achieving sustained virological response (SVR) are still unclear. Many questions remain regarding patient management after viral eradication, such as predicting liver-related complications and the extent to which viral eradication reduces the risk of liver disease progression. Personalized follow-up care based on individual risk is increasingly supported. This narrative review aims to analyze the impact of viral eradication with DAAs on portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as summarize indications for optimal follow-up care of HCV patients treated with DAAs.