Decrease of Alpha-fetoprotein in Patients with Cirrhosis Treated with Direct-acting Antivirals

Background and Aims:The lack of specificity has limited the role of serum alpha-fetoprotein(AFP)for hepatocellular carcinoma(HCC)screening among patients with cirrhosis related to hepatitis C virus(HCV)infection.We sought to examine whether AFP may decrease after achieving a sustained virological response(SVR)in patients with HCV-related cirrhosis.Methods:We performed a retrospective study of patients with HCV-related cirrhosis who were cured with direct-acting antiviral(DAA)therapy at the University of California,Los Angeles.Laboratory values,including serum AFP,were measured before and after completing the DAA treatment.Results:Fifty-six patients met the inclusion criteria,with median(interquartile range[IQR])age of 67(58-69)years and with 51.8%being male.All patients received DAA therapy without interferon.AFP decreased from median(IQR)7.2(4.2-13.4)ng/mL before DAAs to 4.2(2.7-6.3)ng/mL at the end of treatment and 4.2(2.9-6.8)ng/mL at 12 weeks after treatment(P<0.001).Model for end-stage liver disease(MELD),fibrosis-4(FIB4),and aspartate transaminase(AST)to platelet ratio index(APRI)scores at baseline were not significantly associated with AFP reduction.On multivariate analysis,platelet count,AST and total bilirubin at baseline were significantly correlated to AFP reduction(P=0.04,0.009 and 0.04,respectively).The higher the baseline AFP,the greater the reduction in AFP.There was no statistically significant correlation between baseline AFP and MELD,FIB4 or APRI scores.Conclusion:There was a significant decrease in AFP in patients with cirrhosis who achieved a SVR with DAAs.Given a reduction in AFP after DAA treatment,AFP should be further studied as a screening modality for HCC in patients with cirrhosis.