Follow-Up of Patients with Hepatitis C Who Achieved Sustained Virological Response: a Pharmacist-Led Service Evaluation
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Jones A.
Moothathamby T.
Gupta P.
Gill U.
Koffas, A.
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Issue Date
2025
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Article
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The implementation of the national hepatitis C virus (HCV) elimination programme in the UK has resulted in over 80,000 people having been treated for hepatitis C in the UK since 2015.1 However, some of these individuals will be at risk of developing hepatocellular carcinoma (HCC), despite achieving sustained virologic response (SVR). EASL issued a position paper in 2024 on follow-up following successful HCV treatment. 2 Our study aimed to assess the follow-up status of patients who achieved SVR in Barts Health NHS Trust, London, UK, in line with the EASL guidance. A retrospective service evaluation of patients treated for hepatitis C at Barts Health NHS Trust between 2016 and 2024 was conducted. All patients with a baseline liver stiffness measurement (LSM) >8 kPa and/or APRI >1.0 and/or documented history of cirrhosis were included. Diagnosis of steatotic liver disease (SLD), cardiometabolic risk factors and harmful alcohol intake were recorded. Follow-up status and up-to-date liver fibrosis assessment was assessed. HCC development was also documented. Patients with a baseline LSM less than outlined above or with no documented history of cirrhosis were not included. Out of 1346 patients who received treatment for HCV between 2016 and 2024, 262 met the inclusion criteria. 211 patients (80.5%) had a baseline LSM of >10 kPa or were identified as having cirrhosis (Group 1), and 51 patients (19.5%) had a baseline LSM between 8-10 kPa (Group 2). 46 (17.5%) patients had a harmful alcohol history documented and 92 (35.1%) had a diagnosis of SLD. Of the 211 patients in Group 1, 74 (35.1%) remain under active follow up, with 20 (9.5%) deceased, 42 (19.9x%) discharged and 75 (35.5%) lost to follow up. 3 (1.4%) patients in Group 1 developed a hepatocellular carcinoma (HCC). Of the 46 patients in Group 2, 21 (46%) had a repeat LSM post SVR, with 4 (8.7%) LSM's being elevated >8kPA. 1 (25%) of these patients remained under hepatology follow up. 2 (50%) were discharged due to non-attendance, 1 (25%) was lost to follow up. Of the 30 patients who did not receive a repeat LSM, 15 (50%) had potential risk factors for fibrosis progression. A proportion of HCV patients, who achieved SVR, had either been discharged or lost to follow-up. Many of these patients may require long-term follow-up or further non-invasive assessment of their liver fibrosis status. Services might need to adapt their discharge pathways after SVR, to integrate the above.
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