Serum alpha-fetoprotein levels in patients with advanced hepatitis C: results from the HALT-C Trial.
OBJECTIVE
Alpha-fetoprotein (AFP) has been useful in the diagnosis of hepatocellular carcinoma (HCC) but lacks specificity. We assessed serum AFP among patients with chronic hepatitis C and advanced fibrosis to establish predictors of AFP elevations and changes with antiviral therapy.


METHODS
Serum AFP was measured at baseline and on therapy in patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C). AFP levels were correlated with patient demographic and clinical features.


RESULTS
Baseline AFP was > or = 20 ng/mL in 191 of 1145 patients (16.6%). Mean AFP values were significantly higher in patients with cirrhosis than in those with bridging fibrosis (22.5 vs. 11.4 ng/mL, P < 0.0001). Factors independently associated with raised serum AFP in patients with cirrhosis were female gender, black race, decreased platelet count, increased serum AST/ALT ratio, serum ferritin, and Mallory bodies in liver biopsies. Serum AFP levels decreased significantly during therapy with pegylated interferon alpha-2a and ribavirin. HCC was identified in six subjects, only three of whom had AFP > 20 ng/mL.


CONCLUSIONS
Among patients with advanced chronic hepatitis C, serum AFP values are frequently elevated, even in the absence of HCC. Factors associated with raised AFP include severity of liver disease, female gender and black race. Serum AFP levels decline during antiviral therapy.
Di Bisceglie
Adrian M
AM
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Avenue, St Louis, MO 63110, USA. dibiscam@slu.edu
Sterling
Richard K
RK
Chung
Raymond T
RT
Everhart
James E
JE
Dienstag
Jules L
JL
Bonkovsky
Herbert L
HL
Wright
Elizabeth C
EC
Everson
Gregory T
GT
Lindsay
Karen L
KL
Lok
Anna S F
AS
Lee
William M
WM
Morgan
Timothy R
TR
Ghany
Marc G
MG
Gretch
David R
DR
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000378:metabolism*
D015415:Biomarkers; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase