A challenging case of alpha-fetoprotein-result discrepancies in a patient with chronic hepatitis B

Introduction Alpha-fetoprotein(AFP)is the most abundant serum protein found in the human fetus,produced by the yolk sac and the liver[1].The levels of maternal serum AFP reach a peak value at28-32 weeks of gestation and decrease rapidly after birth and usually drop to the normal at 8-12 months of age.The normal serum AFP level for an adult is<20 ng/mL[2].In contrast,livertumor cells usually synthesize and secrete an increased level of AFP.Abdominal ultrasound and AFP are generally recommended as the screening modality for HCC for patients at risk for development of hepatocellular carcinoma(HCC)[1].AFP-L3,an isoform of AFP that binds Lens culinaris agglutinin,can be particularly useful in the early identification of aggressive HCC[2].These assays,however,can generate false-positive and false-negative AFP values.Of patients with advanced HCC,20%had normal AFP levels,whereas some patients with liver diseases had significant AFP elevation without liver cancer in long-term surveillance[3].Elevated AFP levels could be associated with active liver diseases with hepatocyte regeneration[4,5].In that setting,the AFP level will decline with improvement of the underlying liver condition.Our case illustrated the dilemma and uncertainties as a result of persistent abnormal AFP values after extensive clinical investigations.

Improved hepatitis A and hepatitis B vaccination strategy is necessary for patients with chronic hepatitis C

Introduction Hepatitis C virus(HCV)is a major cause of chronic liver diseases.Hepatitis A virus(HAV)or hepatitis B virus(HBV)infection on pre-existing hepatitis C can lead to significant morbidity and mortality[1].The Advisory Committee on Immunization Practices(ACIP)recommends HAV and HBV vaccination for patients with chronic liver diseases[2,3].Best-practice advice from the American College of Physicians and the Centers for Disease Control and Prevention(CDC)also emphasized the importance of HBV vaccination for at-risk populations[4].The hepatitis B vaccine response,however,is generally lower among patients with chronic liver diseases,especially those with cirrhosis or older age[5,6].In this study,we reported that a high proportion of patients with chronic hepatitis C remained at risk of HAV or HBV infection at their referral to our tertiary Liver Center.