Evaluation of Alpha Fetoprotein Results in Chronic Hepatitis C Patients Who Received Directly Acting Antivral Treatment

Öz

Objective: It is to detect a change in the value of alpha fetoprotein, which is an indicator of necroinflammation after direct effective antiviral drug therapy in patients diagnosed with chronic hepatitis C.
Material and Methods: In our study, the data of 294 patients who were evaluated in the Gastroenterology outpatient clinic of Cumhuriyet University Faculty of Medicine between January 2015 and January 2020, and who were diagnosed with chronic hepatitis C and started direct-acting antiviral treatment, were retrospectively analyzed. Patients were evaluated in 2 main groups according to the direct acting antiviral treatments they received. Patients who received sofosbuvir + ledipasvir ± Ribavirin treatment were the first group (n=114) and the patients who received paritaprevir + ritonavir/ Ombitasvir ± Dasabuvir ± Ribavirin treatment were the second group (n=180).
Results: The mean alpha fetoprotein value of the patients before treatment was 8.25±10.82 ng/ml and the mean alpha fetoprotein value at the end of the treatment was 5.14±10.80 ng/ml and this change was statistically significant (p<0.01). In the first group, alpha fetoprotein values at the end of treatment decreased significantly compared to the pretreatment value (p<0.01), whereas in the second group a slight decrease was observed. However, this decrease was not statistically significant (p=0.175).
Conclusion: In our study, it was determined that alpha-fetoprotein values, which is an indicator of necroinflammation, decreased with current antiviral treatments in patients with chronic hepatitis C, and a significant improvement in fibrosis was observed in the early period after treatment with direct-acting antiviral.

Anahtar Kelimeler

• Chronic hepatitis C
• Alpha Fetoprotein
• Direct Acting Antiviral Agents

DİREKT ETKİLİ ANTİVİRAL TEDAVİ ALAN KRONİK HEPATİT C HASTALARINDA ALFA FETOPROTEİN SONUÇLARININ DEĞERLENDİRİLMESİ

Öz

Amaç: Kronik hepatit C tanılı hastalarda doğrudan etkili antiviral ilaç tedavisi sonrasında nekroinflamasyonun bir göstergesi olan alfa fetoprotein değerinde meydana gelen değişimi saptamaktır.
Gereç ve Yöntemler: Çalışmamızda Ocak 2015 ile Ocak 2020 tarihleri arasında Cumhuriyet Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı Polikliniğinde değerlendirilip kronik hepatit C tanısı ile direkt etkili antiviral tedavi başlanan 294 hastanın verileri retrospektif olarak incelenmiştir. Aldıkları direkt etkili antiviral tedavilerine göre; Sofosbuvir/Ledipasvir ± Ribavirin tedavisi alan hastalar 1. grup (n=114), Paritaprevir + Ritonavir/Ombitasvir ± Dasabuvir ± Ribavirin tedavisi alan hastalar 2. grup (n=180) olarak iki ana grupta değerlendirilmiştir.
Bulgular: Hastaların tedavi öncesindeki ortalama alfa fetoprotein değeri 8.25±10.82 ng/ml, tedavi bitimindeki ortalama alfa fetoprotein değeri ise 5.14±10.80 ng/ml olarak saptanmış ve bu değişim istatistiksel olarak anlamlı bulunmuştur (p<0.01). Birinci grupta tedavi bitimindeki alfa fetoprotein değerinde tedavi öncesi değere göre anlamlı düşme gözlenirken (p<0.01), 2. grupta hafif düşme gözlenmiş; ancak bu düşüş istatistiksel olarak anlamlı bulunmamıştır (p=0.175).
Sonuç: Çalışmamızda kronik hepatit C tanılı hastalarda güncel antiviral tedaviler ile nekroinflamasyonun bir göstergesi olan alfa fetoprotein değerlerinde gerileme olduğu saptanmış ve direkt etkili antiviral ile tedavi sonrası erken dönemde fibroziste anlamlı iyileşme olduğu görülmüştür.

Anahtar Kelimeler

• Alfa Fetoprotein
• Kronik hepatit C
• Direkt Etkili Antiviral Ajanlar

Kaynakça

1. 1. Applegate TL, Fajardo E, Sacks JA. Hepatitis C virus diagnosis and the holy grail. Infectious Disease Clinics. 2018;32(2):425-45.
2. 2. Morozov VA, Lagaye S. Hepatitis C virus: Morphogenesis, infection and therapy. World Journal of Hepatology. 2018;10(2):186-212.
3. 3. Meringer H, Shibolet O, Deutsch L. Hepatocellular carcinoma in the post-hepatitis C virus era: Should we change the paradigm? World Journal of Gastroenterology. 2019;25(29):3929-40.
4. 4. Alter HJ. The Gordon Wilson lecture: the hepatitis C virus: from Hippocrates to cure. Transactions of the American Clinical and Climatological Association. 2019;130:104.
5. 5. Ferreira AR, Ramos B, Nunes A, Ribeiro D. Hepatitis C virus: evading the intracellular innate immunity. Journal of Clinical Medicine. 2020;9(3):790.
6. 6. Zając M, Muszalska I, Sobczak A, Dadej A, Tomczak S, Jelińska A. Hepatitis C–New drugs and treatment prospects. European Journal of Medicinal Chemistry. 2019;165:225-49.
7. 7. Coppola N, Alessio L, Onorato L, Sagnelli C, Macera M, Sagnelli E et al. Epidemiology and management of hepatitis C virus infections in immigrant populations. Infectious Diseases of Poverty. 2019;8(1):1-10.
8. 8. Duran AÇ, Çetinkaya ÖK, Sayıner AA, Şeydaoğlu G, Özkarataş E, Abacıoğlu H. Changes on Hepatitis C virus genotype distribution in Western Turkey: Evaluation of twelve-year data. The Turkish Journal of Gastroenterology. 2020;31(2):128-35.

9. 9. Younossi ZM, Racila A, Muir A, Bourliere M, Mangia A, Esteban R et al. Long-term patient centered outcomes in cirrhotic patients with chronic hepatitis C after achieving sustained virologic response. Clin Gastroenterol Hepatol. 2021:S1542-3565(21)00076-8.
10. 10. Zhang M, Zhang L, Li H, Chen Z, Luo A, Liu B et al. Circulating T follicular helper cells are associated with rapid virological response in chronic hepatitis C patients undergoing peginterferon therapy. International Immunopharmacology. 2016;34:235-43.
11. 11. Khan SZ, Talha MU, Iftikhar B, Noor A, Laique T, Latif A et al. Induction of combination therapy for the management of hepatitis C: An observational study. Cureus. 2020;12(9) e10259.
12. 12. Wright C, Cogger S, Hsieh K, Goutzamanis S, Hellard M, Higgs P. “I'm obviously not dying so it's not something I need to sort out today”: Considering hepatitis C treatment in the era of direct acting antivirals. Infection, Disease & Health. 2019;24(2):58-66.
13. 13. Asselah T, Marcellin P, Schinazi RF. Treatment of hepatitis C virus infection with direct‐acting antiviral agents: 100% cure? Liver International. 2018;38(Suppl 1):7-13.
14. 14. Parola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. Molecular Aspects of Medicine. 2019;65:37-55.
15. 15. Manuc D, Preda CM, Sandra I, Baicus C, Cerban R, Constantinescu I et al. Signification of serum alpha-fetoprotein levels in cases of compensated cirrhosis and hepatitis C virus without hepatocellular carcinoma. Journal of Medicine and Life. 2020;13(1):68-74.
16. 16. Khatun M, Ray RB. Mechanisms underlying hepatitis C virus-associated hepatic fibrosis. Cells. 2019;8(10):1249.
17. 17. Rabaan AA, Al-Ahmed SH, Bazzi AM, Alfouzan WA, Alsuliman SA, Aldrazi FA et al. Overview of hepatitis C infection, molecular biology, and new treatment. Journal of Infection and Public Health. 2020;13(5):773-83.
18. 18. Singal AG, Lim JK, Kanwal F. AGA clinical practice update on interaction between oral direct-acting antivirals for chronic hepatitis C infection and hepatocellular carcinoma: expert review. Gastroenterology. 2019;156(8):2149-57.
19. 19. Tada T, Kumada T, Toyoda H, Mizuno K, Sone Y, Kataoka S et al. Improvement of liver stiffness in patients with hepatitis C virus infection who received direct‐acting antiviral therapy and achieved sustained virological response. Journal of Gastroenterology and Hepatology. 2017;32(12):1982-8.
20. 20. Hu K-Q, Kyulo NL, Lim N, Elhazin B, Hillebrand DJ, Bock T. Clinical significance of elevated alpha-fetoprotein (AFP) in patients with chronic hepatitis C, but not hepatocellular carcinoma. Am J Gastroenterol. 2004;99(5):860-5.
21. 21. Bayati N, Silverman AL, Gordon SC. Serum alpha-fetoprotein levels and liver histology in patients with chronic hepatitis C. The American Journal of Gastroenterology. 1998;93(12):2452-6.
22. 22. Chen C-H, Lin S-T, Kuo C-L, Nien C-K. Clinical significance of elevated alpha-fetoprotein (AFP) in chronic hepatitis C without hepatocellular carcinoma. Hepato-gastroenterology. 2008;55(85):1423-7.