Association of liver inflammation with alpha-fetoprotein and treatment response in hepatitis C virus genotype 4 patients

Abstract

Objectives: Chronic hepatitis C (CHC) or liver inflammation resulting from infection with hepatitis C virus (HCV) is the cause of chronic liver disease and leads to cirrhosis and hepatocellular carcinoma. The burden of chronic HCV-related liver disease in Egypt continues to rise and the interaction of liver inflammation with biomarkers and response to therapy is scarcely discussed. Moreover, serum alanine transaminase (ALT) is considered as a moderately accurate test for indicating liver inflammation. This study aims to evaluate the correlation of liver inflammation with response to therapy and with alpha-fetoprotein (AFP), and to assess the potential efficiency of AFP as a marker for liver inflammation. Methods: The study included 134 consecutive Egyptian chronic HCV patients. Sustained virological response (SVR) was assessed by the detection of HCV by reverse polymerase reaction (PCR). Furthermore, fibrosis and necroinflammation were assessed before treatment. Results: Severe liver inflammation was significantly associated with higher pretreatment levels of ALT, aspartate aminotransferase (AST) and AFP. AFP overcomes ALT as marker of inflammation by ROC curve analysis. Early virologic response (EVR), end-of-treatment response (ETR) and SVR was significantly higher in patients with mild inflammation than those with moderate and severe inflammation. Conclusion: Pretreatment AFP levels should be considered as a surrogate marker in predicting liver inflammation. Mild liver inflammation was more prevalent than moderate and severe inflammation in responders by means of EVR, ETR and SVR. d be considered as a surrogate marker in predicting liver inflammation. The response to therapy is more apparent in mild than moderate and severe liver inflammation by means of EVR, ETR and SVR.