Background and study aims: Egypt has the highest prevalence of hepatitis C in the world. Alphafoetoprotein
(AFP) is important in the diagnosis of hepatocellular carcinoma (HCC), but elevated AFP
levels have also been observed in chronic hepatitis C (CHC) without HCC. We evaluated the clinical
correlation between elevated AFP levels and CHC. We analysed data from a population-based cohort of
patients with hepatitis C virus (HCV) infection to assess the prevalence of elevated serum AFP, to determine
its association with clinical and virologic parameters and with clinical outcomes.
Patients and methods: From December 2009 to April 2011, 121 patients with no evidence of HCC with
regular abdominal ultrasound or other imaging studies (multislice computed tomography (MSCT) or
magnetic resonance imaging (MRI)) were controlled by a chart review.
Results: The prevalence of elevated AFPP10 ng ml1 was 11.6%. Univariate analysis revealed that fibrosis
stage III/IV, alanine aminotransferase (ALT) more than 45 IU l1 and platelet count less than 150  109 l1
were significantly associated with elevated AFP. Multivariate analysis revealed that the independent variable
associated with elevated serum AFP was fibrosis stage III/IV, p = 0.015. Multivariate analysis also
revealed that AST > 45 IU l1 and AFP P10 ng ml1 were associated with advanced fibrosis using a cutoff
AFP value >10 ng ml1. The sensitivity and specificity of diagnosing fibrosis score III/IV were 26.1%
and 97.3%, respectively.
Conclusions: Elevated AFP levels were observed in 11.65% of patients with CHC. Elevated AFP levels correlated
positively with fibrosis stage III/IV; ALT elevation, thrombocytopenia and AFP P10 ng ml1 were
associated with advanced fibrosis.