Follow-up of patients with chronic hepatitis C and a sustained viral response

Patients with chronic hepatitis C who achieve a sustained virological response (SVR) after antiviral treatment have improved survival and liver‐related morbidity compared to non‐SVR patients. However, long‐term follow‐up studies in SVR patients have shown that the regression of fibrosis varies and the risk of liver‐related complications remains, even in the absence of cirrhosis. While patients with cirrhosis are still at risk of hepatocellular carcinoma, comorbidities such as diabetes, obesity or alcohol consumption may play a major role in the outcome of liver disease in SVR patients without cirrhosis. The risk of re‐infection is high in patients with a persistent risk of contamination such as IV drug users or men who have sex with men. Thus, in the era of highly efficient DAAs regimens, monitoring after a cure of HCV infection remains a major challenge in SVR patients. This review describes long‐term HCV infection and liver‐related outcomes in SVR patients, as well as the profile of patients who are still at risk of progression, and monitoring techniques including non‐invasive markers for the assessment of fibrosis.