New research from UC San Francisco (UCSF) suggests hepatitis C cure may be reliably confirmed as early as four weeks after treatment, potentially improving care access for underserved populations.
A new study from University of California, San Francisco is challenging long-standing clinical timelines for confirming a cure for
For years, patients treated with direct-acting antivirals (DAAs) have been required to wait at least 12 weeks after completing therapy to confirm cure, known as sustained virologic response at 12 weeks (SVR12). While DAAs cure more than 95% of patients, this extended follow-up period can create significant barriers for vulnerable populations, including people who inject drugs and those experiencing homelessness.
To address this gap, UCSF researchers evaluated whether earlier testing could accurately predict cure. Their findings, published in Open Forum Infectious Diseases, were based on the No One Waits (NOW) study, which examined a streamlined “test-and-treat” model initiated at the point of diagnosis in non-clinical community settings.
Participants received a standard 12-week course of the antiviral combination Sofosbuvir/Velpatasvir and were tested for hepatitis C virus (HCV) RNA at treatment completion, as well as four and 12 weeks afterward. Among patients who completed treatment, undetectable virus levels at the end of therapy predicted cure at 12 weeks in 96.6% of cases, while undetectable levels at four weeks post-treatment predicted cure in 100% of cases.
“This study shows that we can simplify hepatitis C care without compromising accuracy,” said Meghan Morris, PhD, MPH, senior author and professor at UCSF. “Earlier testing doesn’t just confirm cure sooner. It also helps identify the small number of people who don’t clear the virus, so they can be quickly linked back to care instead of being lost in a system that is hard to access.”
Undetectable HCV levels four weeks after treatment accurately predicted cure in all study participants who completed therapy.
Shortening the testing window could help underserved populations avoid barriers tied to repeated follow-up visits.
The study validates earlier cure assessment in community-based settings, not just controlled clinical trials.
Importantly, the study focused on populations often underrepresented in clinical trials, including individuals recruited through street outreach who face challenges like unstable housing and limited access to healthcare.
“Large clinical trials have previously shown that viral suppression four weeks after treatment strongly predicts long-term cure,” Morris added. “This study extends that evidence to real-world community settings and to populations most affected by hepatitis C.”
The findings suggest that earlier endpoints—such as SVR4 (four weeks post-treatment)—could serve as a practical alternative in certain cases, potentially reducing patient drop-off and improving documentation of cure rates.
