Hepatic fibrosis and serum alpha-fetoprotein [AFP] as predictors of response to HCV treatment and factors associated with serum AFP normalisation after treatment

Elevated levels of alpha-fetoprotein [AFP] can be seen in patients with chronic hepatitis C [CHC] and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care [SOC] antiviral therapy in Egyptian chronic hepatitis C virus [HCV]-infected patients and identify factors associated with its changes post treatment. A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48 weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients. High baseline AFP levels were observed in non-respondents [non-sustained virological respondents [non-SVRs]] [P< 0.01]; the AFP level decreased in all patients post treatment [P= 0.01], especially in the SVRs [P < 0.01]. In multivariate analysis, hepatic fibrosis was a predictor of response to treatment [P=0.02], while body mass index [BMI] [25-30 kg mr[2]], hepatic activity [A2], hepatic fibrosis stage [F2-F4] and fibrosis improvement were predictors of AFP difference [P = 0.007, 0.01, 0.012, <0.001, 0.030, and 0.018], respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57 ng dr1 with 50% sensitivity and 68% specificity with area under the curve [AUC] of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58. In chronic HCV-infected patients, serum AFP below 3.57 ng dl[-1] and hepatic fibrosis stage 3 are expected to have good response to treatment; BMI [25-30 kg m[-1]], A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment

Doppler changes in chronic hepatitis C virus Egyptian patients with sustained virological response [SVR]

Duplex-doppler ultrasound is a non-invasive method for the assessment of hepatic haemodynamics beyond conventional gray-scale imaging. The clinical values of the methods used for the grading and staging of chronic hepatitis C virus [HCY] infection and the prediction of hepatic steatosis still have to be determined. Was to study the predictive value of pulse wave Doppler ultrasonography in Egyptian patients treated with interferon and Ribavirin through comparing the heamodynamics before and after treatment as well as the detection of the differences in Doppler parameters in IFN-SYR and IFN-NR patients. This study included 50 Hey patients treated with PEG-IFN and Ribavirin. Thirty six patients showed SYR while the remaining 14 patients were non responders. Real time abdominal ultrasonography was done with special concern on abdominal Doppler. Doppler was done by a single ultrasonographer pre and post treatment with special emphasis on liver heamodynamics [Portal vein diameter, Portal vein flow and mean velocities [PVPV] and [PVMV], portal vein circumference and area, hepatic artery resistance and pulsatility indices [HARI] and [HAPI], as well as splenic vein diameter, splenic artery resistance and pulsatility indices [SARI] and [SAPI]]. Hepatic veins phasicity: [triphasic, biphasic, or monophasic], congestion index [in cm/s], modified hepatic vascular index [in cm/s] [MHI], hepatic vascular index and portal hypetiension index were also measured. All the patients were treated by Pegylated interferon 180 microg/week and Ribavirin 13-15 mg/kg/day for 48 weeks [IfPCR still was positive after 24 weeks of treatment, treatment was discontinued, but the patient remained on follow up]. All patients in the study gave an informed consent. Liver biopsies were done for all patients prior to interferon therapy and at 72 weeks [6 months after the end of treatment] with histopathological grading according to METAYIR score. The chronic Hey infected patients in whom IFN and Ribavirin treatment resulted in complete response [SYR] showed that the mean PVPV was [17.59 +/- 5.79 cm/s] while post treatment was [16.39 +/- 3.76 cm/ s]. HAPI pre treatment was [1.77 +/- 0.7 cm/s], and post treatment was [1.62 +/- 0.46 cm/s], and the HARI pre treatment was [0.61 +/- 0.16 cm/s], while post treatment was [0.61 +/- 0.18 cm/s], with no statistical significant difference in the responder group, while the SVMV showed statistical significant difference pre [18.8 +/- 7.37 cm/s], and post treatment [15.2 +/- 4 cm/s]. Also the SVMV pre treatment was [14.7 +/- 5.71 cm/s], while post treatment was[12 +/- 3.74 cm/s], and this was statistically significant [p<0.05]. Pulse wave Doppler ultrasonography is an easy and non-invasive procedure for evaluating the chronic HCY liver disease, but not effective nor valid to estimate the effect and response to anti-viral therapy

Serum selenium concentrations in Egyptian chronic liver disease patients

Disturbance in the antioxidant system could play a role in pathogenesis of chronic liver disease. The most important defence mechanisms are associated with the activity of antioxidative enzymes, among which glutathione peroxidase [GSH-Px], belonging to so-called free radical scavengers, should be mentioned. Selenium, regarded as a bioelement, is present in GSH-Px. Involved in numerous redox reactions, it belongs to the factors protecting the organism from oxidative shock. To detect selenium concentrations in the serum of chronic liver disease patients whether compensated, decompensated or with hepatocellular carcinoma, and to correlate these levels with the progression of liver disease. This study was conducted on 20 patients with compensated liver disease [Group I], 20 patients with decompensated liver disease [Group II], and 10 patients with hepatocellular carcinoma [Group III], all compared with 20 healthy subjects serving as a control group. Participants were subjected to complete clinical and laboratory assessment, and abdominal ultrasonography. Estimation of serum selenium by Graphite Furnace Atomic Absorption Spectrometers was conducted on all samples. There was significant decrease in serum selenium level in hepatocellular carcinoma group compared to both decompensated and compensated groups [26.40 +/- 6.52ug/l, 42.35 +/- 6.12 ug/1 and 59.90 +/- 8.20 ug/1, respectively], when compared to control group [79.85 +/- 10.06 ug/1] [P < 0.01]. There was a significant positive correlation between serum selenium and albumin levels in the studied groups [P < 0.01]. A significant inverse correlation was found between serum selenium level and AST, total bilirubin and alkaline phosphatase in patients groups [P < 0.05]. No significant relationship was found between serum selenium level and age of patients. Serum selenium levels significantly decrease in relation to the progression of chronic liver disease. There is a potential need of selenium supplementation in these patients

Serum zinc concentration in Egyptian patients with chronic hepatitis C

The prevalence of HCV infection varies throughout the world, with the highest number of infections reported in Egypt. Zinc has been closely related to the pathogenesis of chronic hepatitis C. Zinc deficiency causes reduction in glutathione [GSH] which has been implicated in various cellular events. Zinc may play an important role as a negative regulator in HCV replication; zinc supplementation increases the therapeutic response of Interferon [IFN]. To detect serum zinc concentration in adult patients with chronic [compensated] hepatitis C prior to treatment with IFN, and correlate the levels with the degree of inflammation and stage of fibrosis. This study was conducted on 40 adult patients chronically infected with HCV as well as 10 healthy subjects serving as a control group. Participants were subjected to complete clinical and laboratory assessment, quantitative analysis of HCV RNA by PCR technique and abdominal ultrasonography, in addition to estimation of serum Zinc by Graphite Furnace Atomic Absorption Spectrometer. A significant negative correlation was found between the level of zinc and liver fibrosis. The mean value of zinc in patients was 39.5ug/dl, while in the control it was 75ug/dl [normal range: 70-80ug/dl]. There was a non significant negative correlation between serum zinc and serum AST, ALT, disease activity and level of viraemia. Our study suggested the possible important protective role of zinc in patients with chronic hepatitis C, as serum zinc levels showed negative significant correlation with the stage of liver fibrosis

Nutritional status and serum leptin levels among a group of chronic liver disease Egyptian patients

Chronic liver disease [CLD] is one of the most prevalent morbidity problems in Egypt. A balanced diet can actually help the damaged liver to regenerate new liver cells. Early nutritional assessment and dietetic interventions are keys in helping to provide optimum success with these patients. Leptin is an adipose-derived hormone that plays an important role in regulating food intake and energy expenditure in mammals. Investigating the dietary characteristics as well as the overall nutritional status in relation to serum leptin levels in a group of Egyptian CLD patients. This was a descriptive exploratory study. It was conducted in the Tropical Medicine Department in one of the tertiary Care University Hospitals in Egypt. Commonly adopted last year dietary pattern was assessed in 59 males and 31 females with CLD. The body mass index [kg/m[2] was used to express the overall nutritional status. Serum leptin levels were determined by ELISA. Patients were categorized using the modified Child- Pugh criteria. Though most of the patients were diagnosed since more than a year ago, their food pattern was unbalanced. The most commonly and frequently food items included low cost cereals, fresh vegetables and fruits. Additionally, skimmed white cheese was the main source of high biological value proteins. Fats and oils were the least consumed especially by the Child C patients. In the advanced stages of liver disease, there was a significant decline in serum leptin levels if compared with the early stages. Significant positive correlations were found between serum leptin levels with the BMI in the overall patients and in both sexes specially females. Most of the studied patients did not follow balanced diet. Serum leptin levels tend to decline as liver function worsens. The physiologic correlations of serum leptin levels, sex and BMI were all preserved in CLD patients. Patients with CLD especially who live at the border line and mostly due to HCV, should be highlighted as one of the nutritionally at-risk groups. Serum leptin levels should be put into consideration while providing the timely appropriate nutritional guidance and counseling to the CLD patients