Long-term Kinetics of Alpha-fetoprotein in Chronic Hepatitis C Patients Treated with Direct-acting Antivirals and Possible Predictive Role of AFP Response to Treatment on Development of Hepatocellular Carcinoma

Abstract

Objectives: To evaluate the post-treatment upto fourth-year kinetics of alpha-fetoprotein (AFP) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral (DAA) drugs. Materials and Methods: In this retrospective, single-center study, 182 patients (124 female, 58 male) with CHC treated with DAA were included in the study. Biochemistry and AFP were recruited from the hospital database. The data at pre-treatment, 3rd and 48th month after the end of treatment were evaluated. Results: Of the 182 patients, mean age was 58 +/- 12 (28-76), and forty-nine (27%) had cirrhosis. At month 3, the average decline of AFP was 35.6% (0.4-97.0). Early decline of AFP <8.7% was found to be a predictor for HCC development. Mean AFP was 7.7 +/- 9.2 ng/mL at pre-treatment and 3.8 +/- 2.7 at third month (p<0.001). The decline persisted at 48th month (3.6 +/- 2.4 ng/mL). Conclusion: Early decline of AFP and persistence at fourth-year after DAA treatment was observed, except five cases developing HCC. Inadequate decline in AFP level found to be a possible predictor for HCC development. However, these results needs to be confirmed in large-scale multicenter cohorts. This study highlights the importance of AFP response to DAA treatment in identifying HCC risk, especially in patients with cirrhosis.