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Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment.
Arab J Gastroenterol. 2013 Sep; 14(3):94-8.AJ

Abstract

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 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.

CONCLUSION

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+Show Affiliations

Endemic Medicine, Hepatogastroenterology Department, Cairo University, Cairo, Egypt. Electronic address: maelraziky@yahoo.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24206736

Citation

El Raziky, Maissa, et al. "Hepatic Fibrosis and Serum Alpha-fetoprotein (AFP) as Predictors of Response to HCV Treatment and Factors Associated With Serum AFP Normalisation After Treatment." Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, vol. 14, no. 3, 2013, pp. 94-8.
El Raziky M, Attia D, El Akel W, et al. Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment. Arab J Gastroenterol. 2013;14(3):94-8.
El Raziky, M., Attia, D., El Akel, W., Shaker, O., Khatab, H., Abdo, S., Elsharkawy, A., & Esmat, G. (2013). Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment. Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, 14(3), 94-8. https://doi.org/10.1016/j.ajg.2013.08.005
El Raziky M, et al. Hepatic Fibrosis and Serum Alpha-fetoprotein (AFP) as Predictors of Response to HCV Treatment and Factors Associated With Serum AFP Normalisation After Treatment. Arab J Gastroenterol. 2013;14(3):94-8. PubMed PMID: 24206736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatic fibrosis and serum alpha-fetoprotein (AFP) as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment. AU - El Raziky,Maissa, AU - Attia,Dina, AU - El Akel,Wafaa, AU - Shaker,Olfat, AU - Khatab,Hany, AU - Abdo,Shaimaa, AU - Elsharkawy,Aisha, AU - Esmat,Gamal, Y1 - 2013/10/10/ PY - 2012/03/19/received PY - 2012/08/28/revised PY - 2013/05/02/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/10/31/medline KW - ALT KW - AST KW - AUC KW - Alpha-fetoprotein KW - Chronic hepatitis C virus KW - HBcAb KW - HBsAb KW - Hepatic fibrosis KW - ROC KW - SVR KW - U/L KW - ULN KW - alanine aminotransferase KW - area under the curve KW - aspartate aminotransferase KW - hepatitis B virus core antibodies KW - hepatitis B virus surface antibodies KW - receiver operator curve KW - sustained virological response KW - unit/litre KW - upper limit of normal SP - 94 EP - 8 JF - Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology JO - Arab J Gastroenterol VL - 14 IS - 3 N2 - 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 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. CONCLUSION: 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. SN - 2090-2387 UR - https://www.unboundmedicine.com/medline/citation/24206736/Hepatic_fibrosis_and_serum_alpha_fetoprotein__AFP__as_predictors_of_response_to_HCV_treatment_and_factors_associated_with_serum_AFP_normalisation_after_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1687-1979(13)00122-6 DB - PRIME DP - Unbound Medicine ER -