Poster (15W175)

Effect of direct acting antiviral therapy on AFP levels in patients treated for hepatitis C cirrhosis

Author(s)

Andrew Carroll, John O'Grady, Orla Crosbie

Department(s)/Institutions

Cork University Hospital

Introduction

Hepatitis C virus affects between 170- 185 million people worldwide, hepatocellular carcinoma (HCC) is a wellrecognised complication, particularly in the context of cirrhosis. Alpha fetoprotein (AFP) is an onco-foetal protein found in increased levels in HCC, liver metastasis and other benign liver conditions.

Newer direct acting antiviral (DAA) therapies are showing higher rates of sustained virologic response (SVR) than the more traditional interferon based regimes in Hepatitis C treatment. HCC risk is reduced with SVR in interferon based therapy, with absolute risk reduction of 4.6%. In advanced liver disease, 4.2% with SVR develop HCC compared to 17.8% of non responders. A higher reduction in AFP level was seen following triple therapy with Telepravir compared to interferon based therapy. We sought to investigate AFP level with DAA therapy in our centre.

Method

All cirrhotic patients treated with DAAs for hepatitis C were analyzed. Exclusion criteria were those who discontinued treatment or who died prior to completion. 28 patients were suitable for inclusion, 9 of which are still undergoing treatment.

Results

Of 28 patients, 16 were female and 12 male. Average age was 57 years (range 36- 73). All patients became virus negative on treatment, the earliest occurring at week two. 3 patients relapsed following treatment.

AFP levels decreased following treatment. Pre treatment levels averaged 46.6 ng/ml (1.4- 265) and post treatment 38.7 ng/ml (1- 93). AFP treatment levels are awaited on 5 patients. Individual case analysis revealed that all but one case showed a decrease following treatment.

Mean bilirubin levels pre and post treatment were similar at 19.1 mg/dl (5- 79) and 19.7 mg/dl (5- 100) respectively. However there was an overall trend for levels to rise transiently during the first month of treatment to an average level of 27.9 mg/dl (9- 54).

ALT levels decreased following treatment from mean levels of 94.7 U/L (18- 260) to 30.25 U/L (10- 50).

Conclusions

Our sample suggests that notable decreases occur in AFP levels with DAAs, in keeping with recent studies. This may suggest a reduced risk of HCC with DAA therapy, given the known association between AFP level and HCC risk. Long term follow up is required to determine if there will be a similar HCC risk reduction associated w