Continuity of long-term follow-up in patients with chronic hepatitis C after sustained virologic response following direct-acting antiviral therapy: a nationwide real-world multicenter cohort study in Japan

BACKGROUND: Long-term follow-up is essential after a sustained virologic response (SVR) to direct-acting antivirals (DAAs) in patients with chronic hepatitis C. However, real-world continuity of care and determinants of disengagement are poorly characterized at the national level. Here, we quantified the follow-up continuity within Japan's government-designated regional core centers and identified independent factors associated with transfer and self-discontinuation. METHODS: We conducted a retrospective multicenter cohort study of 3702 patients with chronic hepatitis C who achieved SVR at 16 regional core centers (2015-2018). Continuation was assessed using Kaplan-Meier analysis and competing-risk analysis, and Fine-Gray regression identified determinants of transfer and discontinuation. RESULTS: At 5 years, 56% of the patients were followed up, 24% were transferred, and 18% self-discontinued. Older age was significantly associated with transfer (subdistribution hazard ratio [sHR] 1.41, 95% CI 1.23-1.61), whereas hepatocellular carcinoma (HCC) and other malignancies favored continuous follow-up. Self-discontinuation was more frequent with hepatitis C virus (HCV) serotype 2 (sHR 1.36, 95% CI 1.18-1.57) and less common among patients with advanced disease or prior hospitalization. CONCLUSIONS: Within Japan's core-center network, long-term continuation after SVR is high but not universal. Follow-up was generally maintained for patients with severe comorbidities, while disengagement was more likely among those with lower perceived risk. Strengthening low-intensity, structured support for such patients may improve the continuity and equity of post-SVR care. These findings provide a foundation for optimizing post-SVR care pathways in national liver disease networks.