Predictive Role of Acute Phase Reactants in the Response to Therapy in Patients with Chronic Hepatitis C Virus Infection

Abstract

Background/AimsBiochemical parameters and acute-phase proteins (APPs) may provide complementary data in patients with chronic hepatitis C (CHC). We aimed to evaluate the predictive role of APPs in the response to antiviral therapy.MethodsForty-five patients underwent antiviral therapy. Serum ferritin, C-reactive protein (CRP), transferrin, albumin, alpha-1 acid glycoprotein (A1AG), and alpha-2 macroglobulin (A2MG) levels were examined at the initial evaluation and at the 4th, 12th, and 48th weeks. HCV RNA levels were examined at the initial evaluation and at the 12th and 48th weeks.ResultsFerritin, transferrin, A1AG, and A2MG levels were significantly higher in the patient group (p<0.05). CRP, ferritin, A1AG, and A2MG levels were significantly increased from baseline to the 4th week (p<0.05). The responders and nonresponders to antiviral therapy had insignificantly but remarkably different levels of CRP, ferritin, transferrin, A1AG, A2MG, and alanine aminotransferase (ALT) both at the initial evaluation and at the 12th week.ConclusionsVariations in ferritin, A1AG, A2MG, albumin, CRP, and transferrin levels are not alternatives to virological and biochemical parameters for predicting an early response to therapy in patients with CHC. However, the investigation of ALT levels and hepatitis C virus RNA in combination with acute-phase reactants may provide supplementary data for evaluating responses to antiviral therapy.

Inflammatory and cardiovascular diseases biomarkers in chronic hepatitis C virus infection: A review

“…In a study of patients with angiographically documented CAD, CRP, and fibrinogen levels were significantly elevated in HCV‐infected patients compared to controls and HCV seropositivity was associated with increased severity of CAD . Similar results were reported with elevated high‐sensitivity CRP (hsCRP) levels and CVD in some studies, whereas others found no differences in CRP levels among HCV patients and controls …”

“…Numerous studies have reported decreased CVD clinical endpoints and mortality with HCV therapy . There were conflicting results about the change of these biomarkers in response to HCV treatment, and these differing results may have been due to heterogeneous study designs, variable study populations, and different treatment regimens among studies . Despite this variability, it was clear that eradication of HCV does have an effect on the HCV driven inflammatory and immune responses with a general trend towards return to normal levels of these markers.…”

“…103 Similar results were reported with elevated high-sensitivity CRP (hsCRP) levels and CVD in some studies, 103,104 whereas others found no differences in CRP levels among HCV patients and controls. 105 Among the reported studies, few have linked altered levels of biomarkers with subclinical and clinical CVD in CHC. Tsui et al demonstrated increased levels of CRP, TNF-α, IL-6, and hospitalizations due to clinical cardiac failure among HCV positive patients compared to controls.…”

“…102 Finally, many studies investigated the effect of HCV therapy on inflammatory markers and the majority demonstrated that HCV therapy significantly altered levels of inflammatory levels and/or predicted treatment success. 22,[46][47][48]62,65,70,71,[78][79][80]89,96,105 Taken the together, the preponderance of data shows a clear modulation of the immune system, an imbalance of pro-and antiinflammatory biomarkers with a shift towards a proinflammatory state, and increased serum inflammatory levels among CHC-infected patients. However, possibly due to blunted hepatocyte response and decreased production of CRP, CHC patients may score lower on CVD risk assessment models which rely heavily on CRP values.…”

Alpha-2 Macroglobulin Is The Simplest Serum Biomarker For Liver Fibrosis And Fibrogenesis In Chronic Hepatitis C

“…In the context of acute-phase proteins, A2MG is synthesized in hepatocytes and stellate cells (11)(12). Both its hepatic and serum levels increase in fibrogenetic environment (13).…”