Clinical significance of elevated alpha-foetoprotein (AFP) in patients with chronic hepatitis C without hepatocellular carcinoma in upper EGYPT.

BACKGROUND AND STUDY AIMS: Egypt has the highest prevalence of hepatitis C in the world. Alpha-foetoprotein (AFP) is important in the diagnosis of hepatocellular carcinoma (HCC), but elevated AFP levels have also been observed in chronic hepatitis C (CHC) without HCC. We evaluated the clinical correlation between elevated AFP levels and CHC. We analysed data from a population-based cohort of patients with hepatitis C virus (HCV) infection to assess the prevalence of elevated serum AFP, to determine its association with clinical and virologic parameters and with clinical outcomes. PATIENTS AND METHODS: From December 2009 to April 2011, 121 patients with no evidence of HCC with regular abdominal ultrasound or other imaging studies (multislice computed tomography (MSCT) or magnetic resonance imaging (MRI)) were controlled by a chart review. RESULTS: The prevalence of elevated AFP ≥10ngml(-1) was 11.6%. Univariate analysis revealed that fibrosis stage III/IV, alanine aminotransferase (ALT) more than 45IUl(-1) and platelet count less than 150×10(9) l(-1) were significantly associated with elevated AFP. Multivariate analysis revealed that the independent variable associated with elevated serum AFP was fibrosis stage III/IV, p=0.015. Multivariate analysis also revealed that AST>45IUl(-1) and AFP ≥10 ngml(-1) were associated with advanced fibrosis using a cut-off AFP value >10 ngml(-1). The sensitivity and specificity of diagnosing fibrosis score III/IV were 26.1% and 97.3%, respectively. CONCLUSIONS: Elevated AFP levels were observed in 11.65% of patients with CHC. Elevated AFP levels correlated positively with fibrosis stage III/IV; ALT elevation, thrombocytopenia and AFP ≥10 ngml(-1) were associated with advanced fibrosis.

The relationship between core promoter mutation of hepatitis B virus, viral load and hepatitis B e antigen status in chronic hepatitis B patients.

The aim of this study is to detect the possible association of hepatitis B virus (HBV) core mutation, hepatitis B e antigen (HBeAg) status and the viral load in chronic hepatitis B (CHB) patients. Sixty-six patients with CHB were enrolled. Hepatitis markers and hepatitis C virus antibody (HCV-Ab) were tested using micro particle enzyme immunoassay kits. Viral load was measured by real-time polymerase chain reaction (PCR) and the mutation was analyzed by nested PCR followed by restriction fragment length polymorphism. Most of CHB patients were HBeAg (-ve). The HBeAg status did not have an influence on the presence or absence of T1762/A1764 mutation. HBV-DNA serum level was not significantly different in patients with core mutation and patients without core mutation in HBeAg (-ve) group, while in HBeAg (+ve) group HBV-DNA serum level was significantly higher in patients with core mutation. This study reports the predominance of HBeAg (-ve) and HBV core promoter mutation.