Hepatitis C Treatment and Sustained Virologic Response

Updated on March 17, 2021

Medically reviewed by Anju Goel, MD, MPH

A sustained virologic response (SVR) for people with a hepatitis C infection simply means that no hepatitis C virus (HCV) can be found in blood at 12 and 24 weeks after completing a course of hepatitis C treatment. SVR very likely means that the HCV infection is cured, and has been used in studies as the ultimate goal of HCV therapy. In most cases, if HCV viral load remains undetectable 24 weeks after the completion of treatment, it remains undetectable for life.

In almost all cases, people with an SVR of 24 weeks are unlikely to experience viral rebound (i.e., a return of virus).

Man holding a glass of water examining a pill — Paul Bradbury / Getty Images

Defining SVR and Other Virologic Responses

Following the initiation of hepatitis C therapy, the blood is tested to measure the quantity of the hepatitis C virus (the viral load). The ultimate goal is to achieve an undetectable viral load. "Undetectable," in this case, doesn't necessarily mean zero or the complete absence of viral activity in the body; rather, it is defined as having no detectable virus in the blood using current testing technologies.

Each stage of response is given a classification, with some stages correlating to a greater or lesser likelihood of treatment success. Take a look at this chart, below.

Term	Meaning	Definition	Prognosis
RVR	Rapid viral response	An undetectable viral load after four weeks of treatment	Generally more likely to achieve SVR
eRVR	Extended rapid viral response	An undetectable viral load at week 12, following the initial RVR	Generally more likely to achieve SVR
EVR	Early viral response	An undetectable viral load or a 99 percent reduction in viral load by week 12	Failure to achieve EVR correlates to less than a 4 percent chance of achieving SVR
ETR	End of treatment response	An undetectable viral load achieved by the end of week 12	Not helpful in predicting treatment outcomes
Partial responder		Able to achieve EVR but unable to sustain an undetectable viral load 24 weeks after therapy completion	Considered treatment failure
Null responder		Unable to achieve EVR by week 12	Treatment is typically terminated if EVR is not achieved by week 12
SVR	Sustained viral response	Able to sustain an undetectable viral load for 12 weeks (SVR-12) and 24 weeks (SVR-24) following completion of therapy	SVR-24 is considered a “cure,” and patients with SVR-12 are usually able to achieve SVR-24

Increasing Your Chances of Achieving SVR

One of the main determinants of SVR success is timing. Treatment, when you have been infected for a short time, is somewhat more likely to work than treatment in patients who have been infected for many years. By treating your infection before there is marked liver damage, you generally have a better chance of achieving a clinical cure for HCV.

Additionally, newer-class direct-acting antivirals (DAAs) have had a profound effect on SVR rates in people with chronic HCV infection. Even in people with compensated cirrhosis, who had previously had a 50/50 chance of treatment success, SVR rates have gradually climbed to 95 percent and above in many of these cases.

What Failing to Achieve SVR Means

While the goal of HCV therapy is to effectively eradicate the virus and to allow a person to live a healthy, hepatitis-free life, a patient shouldn't despair if he or she is unable to achieve these goals. Even if you have only a partial response, studies have shown that the benefits to the liver can be profound—not only slowing the course of the disease but in some cases reversing fibrosis, even in those with marked liver damage.

If you fail your first or second round of therapy, take time to monitor your blood results with your healthcare provider. If you feel that you are ready to try again, your healthcare provider can perform a number of tests to determine which drugs may provide you with the best chance of achieving SVR success.

Reasons Why You May Not Achieve SVR

It's not entirely clear why a small percentage of patients don't reach SVR, but the following factors can play a role:

Failure to adhere to treatment or complete treatment
The specific genotype of your hepatitis
Underlying liver disease
A drug-resistant virus
Concurrent HIV
Baseline viral load
Alcohol use
Age

Coping With Hepatitis C

Don't let a hepatitis C infection make you feel isolated. There is help available. Beyond asking your friends and family members to help you during your journey, you may find comfort joining the active hepatitis C community online or a chronic hepatitis support group. Also, learning more about chronic hepatitis nutrition can both make you feel better and potentially improve your treatment response.

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