Effect of antiviral treatment on alfa-fetoprotein levels in HBV-related cirrhotic patients: early detection of hepatocellular carcinoma.

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J Viral Hepat. 2010 Jul;17(7):511-7. Epub 2009 Oct 8.

Effect of antiviral treatment on alfa-fetoprotein levels in HBV-related

cirrhotic patients: early detection of hepatocellular carcinoma.

Luo K, Liu Z, Karayiannis P.

Department of Infectious Diseases and Hepatology Center, Nanfang Hospital,

Southern Medical University, Guangzhou, China. luokangxian@...

Abstract

Alpha-fetoprotein (AFP) is a marker of the presence of hepatocellular carcinoma

(HCC), but is also elevated in advanced chronic hepatitis B. The detection and

usage of AFP tests need to be improved. A cohort of 101 patients with advanced

chronic hepatitis B and elevated AFP values was treated with entecavir (ETV) or

peginterferon-alpha2a. ETV was more effective in reducing AFP levels; mean time

to AFP normalization was 11.9 weeks after ETV treatment initiation vs 22.3 weeks

in peginterferon treated patients (P = 0.000). An additional cohort of 93

hepatitis B virus (HBV) cirrhotic patients with elevated AFP were treated with

ETV prospectively and maintained under intensive surveillance. HCC developed in

16 (17.2%) patients in whom the strongest independent predictor was a continued

AFP rise in spite of ongoing treatment. In this context, nodules of sizes 10-14

mm and 15-20 mm were detected in 40% of patients each. In conclusion, HBV

cirrhotic patients with rising AFP levels were at very high risk of HCC

development. Early detection of minute lesions may be possible by monitoring AFP

levels, whilst patients are on treatment in conjunction with enhanced computed

tomography examination.

PMID: 19818003 [PubMed - indexed for MEDLINE]