Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment

详细信息    查看全文

• 作者：Maissa El Raziky ; Dina Attia ; Wafaa El akel ; Olfat Shaker ; Hany Khatab ; Shaimaa Abdo ; Aisha Elsharkawy ; Gamal Esmat
• 关键词：U/L ; unit/litre ; ALT ; alanine aminotransferase ; AST ; aspartate aminotransferase ; ULN ; upper limit of normal ; HBsAb ; hepatitis B virus surface antibodies ; HBcAb ; hepatitis B virus core antibodies ; AUC ; area under the curve ; ROC ; receiver operator curve ; SVR ; sustained virological response
• 刊名：Arab Journal of Gastroenterology
• 出版年：September, 2013
• 年：2013
• 卷：14
• 期：3
• 页码：94-98
• 全文大小：365 K

文摘

Background and study aim

Elevated levels of alpha-fetoprotein (AFP) can be seen in patients with chronic hepatitis C (CHC) and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care (SOC) antiviral therapy in Egyptian chronic hepatitis C virus (HCV)-infected patients and identify factors associated with its changes post treatment.

Patients and methods

A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48 weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients.

Results

High baseline AFP levels were observed in non-respondents (non-sustained virological respondents (non-SVRs)) (P < 0.01); the AFP level decreased in all patients post treatment (P = 0.01), especially in the SVRs (P < 0.01). In multivariate analysis, hepatic fibrosis was a predictor of response to treatment (P = 0.02), while body mass index (BMI) (25-30 kg m^鈭?), hepatic activity (A2), hepatic fibrosis stage (F2-F4) and fibrosis improvement were predictors of AFP difference (P = 0.007, 0.01, 0.012, <0.001, 0.030, and 0.018), respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57 ng dl^鈭? with 50% sensitivity and 68% specificity with area under the curve (AUC) of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58.

Conclusion

In chronic HCV-infected patients, serum AFP below 3.57 ng dl^鈭? and hepatic fibrosis 猢絪tage 3 are expected to have good response to treatment; BMI (25-30 kg m^鈭?), A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment.