A 52-year-old man visits the clinic for a follow-up appointment. He has a history of chronic hepatitis C virus (HCV) infection, genotype 1a. He has just taken the final dose of a 12-week regimen of daily glecaprevir-pibrentasvir. Prior to initiating therapy, baseline testing for hepatitis B virus and HIV was negative, and liver transient elastography demonstrated a fibrosis score of F2 (moderate fibrosis). The patient reports feeling well and has experienced no adverse effects from the medication. He has no history of alcohol use disorder. Physical examination shows no jaundice, spider angiomata, or hepatosplenomegaly.
Serial laboratory results are as follows:
| Parameter | Baseline (Day 0) | Week 4 | Today (Week 12) |
|---|---|---|---|
| ALT | 78 U/L | 22 U/L | 19 U/L |
| AST | 65 U/L | 18 U/L | 16 U/L |
| Total bilirubin | 0.9 mg/dL | 0.8 mg/dL | 0.7 mg/dL |
| HCV RNA | IU/mL | Not measured | Not measured |
The patient asks how the clinical team will determine if his liver infection has been fully cured by the antiviral regimen. Which of the following is the most appropriate next step in evaluating the success of this patient's treatment?
- Measure serum HCV RNA level 12 weeks from todayAnswer
- BMeasure serum HCV RNA level today to establish an end-of-treatment baseline
- CMeasure quantitative serum HCV antibody titer 12 weeks from today
- DSchedule a right upper quadrant ultrasound in 6 months for cancer surveillance
- EOrder a multiphasic abdominal computed tomography scan today