Dramatic Reduction of the α-Fetoprotein Level After Lamivudine Treatment of Patients with Chronic Hepatitis B Virus Infection and Cirrhosis

Abstract

Markedly elevated alpha-fetoprotein levels in the range of >1,000 ng/mL are highly suspicious for the presence of hepatocellular carcinoma. This report describes three patients with cirrhosis and replicating hepatitis B virus infection who presented with initial serum alpha-fetoprotein levels of >1,000 ng/mL without clear evidence of hepatocellular carcinoma based on multiple abdominal imaging studies. Initiation of lamivudine treatment led to rapid and dramatic reductions in the alpha-fetoprotein level to the normal range within 12 weeks in one patient and by >1 log at 7 and 16 weeks in the other two patients. One of the three patients previously developed lamivudine resistance, and discontinuation of lamivudine led to a severe flare of hepatitis B before lamivudine treatment was restarted. During a follow-up period of 14 to 36 months, all three patients maintained stable alpha-fetoprotein levels and had no signs of hepatocellular carcinoma demonstrated by serial abdominal imaging studies. The dramatic decrease in the alpha-fetoprotein levels in these patients is unlikely to be a spontaneous event but is possibly due to suppression of viral replication and associated hepatic inflammatory activities by lamivudine. These observations may be helpful in the diagnostic evaluation and management of patients with markedly elevated alpha-fetoprotein levels and chronic hepatitis B-related cirrhosis.

Serum alpha-fetoprotein levels in patients with advanced hepatitis C: Results from the HALT-C Trial

“…2). Previous reports have documented a decrease in AFP in patients with chronic hepatitis B during lamivudine treatment [31] and case reports have documented a similar pattern of AFP improvement during antiviral therapy of hepatitis C [32]. In this study, the average decrease in AFP levels between baseline and 20 weeks of treatment was approximately 40%.…”

Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare

“…Longitudinal studies showed that elevations of serum AFP levels at baseline in CHB patients confirmed by liver biopsy had been proven to be associated with a higher risk of decompensated cirrhosis, hepatocellular carcinoma (HCC), 16,17 implying that patients with elevated serum AFP had more advanced liver disease than did those with normal levels. Very high levels of serum AFP suggestive of the possibility of HCC were occasionally found in patients with chronic HBV infection, especially those with cirrhosis, but no occurrence of HCC 18,19 . In the setting of chronic hepatitis C, the mean serum AFP value was significantly greater in patients with more marked fibrosis 20 .…”

Gamma-glutamyl transpeptidase and α-fetoprotein

“…Previous reports have documented a decrease in AFP in patients with chronic hepatitis B during lamivudine treatment [17] and case reports have documented a similar pattern of AFP improvement during antiviral therapy of hepatitis C [18].…”