A 52-year-old man with compensated cirrhosis secondary to HCV infection (Child-Pugh A5) achieved sustained virological response (SVR) 2 years ago with sofosbuvir/velpatasvir. He undergoes routine hepatocellular carcinoma surveillance. HCC screening with US and AFP is recommended at which interval?

• A Annually (every 12 months)
• B Every 3 months given prior HCV infection
• C Every 6 months ✓
• D No surveillance needed after achieving SVR

Explanation

AASLD and EASL guidelines recommend HCC surveillance with abdominal ultrasound plus AFP every 6 months in all patients with cirrhosis, regardless of HCV SVR status, because cirrhotic liver architecture persists and HCC risk, while reduced (~75% reduction), is not eliminated by HCV cure. Studies confirm sustained HCC risk even 5–10 years post-SVR in those with pre-existing cirrhosis. Annual screening is insufficient to detect early-stage curable HCC. MRI/CT can replace ultrasound when ultrasound is technically inadequate.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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