title: Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment.
abstract: OBJECTIVE
  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.
  
  
  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 48weeks 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) (25-30kgm(-2)), 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 3.57ngdl(-1) 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.
  
  
  CONCLUSIONS
  In chronic HCV-infected patients, serum AFP below 3.57ngdl(-1) and hepatic fibrosis ⩽stage 3 are expected to have good response to treatment; BMI (25-30kgm(-1)), A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment.
authors.affiliation: Endemic Medicine, Hepatogastroenterology Department, Cairo University, Cairo, Egypt. Electronic address: maelraziky@yahoo.com.
authors.forename: Maissa
authors.initials: M
authors.lastname: El Raziky
authors.forename: Dina
authors.initials: D
authors.lastname: Attia
authors.forename: Wafaa
authors.initials: W
authors.lastname: El Akel
authors.forename: Olfat
authors.initials: O
authors.lastname: Shaker
authors.forename: Hany
authors.initials: H
authors.lastname: Khatab
authors.forename: Shaimaa
authors.initials: S
authors.lastname: Abdo
authors.forename: Aisha
authors.initials: A
authors.lastname: Elsharkawy
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012372:ROC Curve; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D019562:Viral Load; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D000509:alpha-Fetoproteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b
keywords: ALT; AST; AUC; Alpha-fetoprotein; Chronic hepatitis C virus; HBcAb; HBsAb; Hepatic fibrosis; ROC; SVR; U/L; ULN; alanine aminotransferase; area under the curve; aspartate aminotransferase; hepatitis B virus core antibodies; hepatitis B virus surface antibodies; receiver operator curve; sustained virological response; unit/litre; upper limit of normal