25-Vitamin D levels in chronic hepatitis C infection: association with cirrhosis and sustained virologic response

Backstedt, David W.; Pedersen, Mark; Choi, Myunghan; Seetharam, Anil

doi:10.20524/aog.2017.0120

Cited by 15 publications

(20 citation statements)

References 24 publications

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“…There is emerging data showing vitamin D deficiency being associated with advanced degrees of fibrosis in chronic HCV infection [ 21 ]. We also observed a high prevalence of vitamin D deficiency in our study population with the significantly higher number of deficiency and insufficiency of vitamin D levels in the cirrhotic subgroup, which is consistent with the published literature [ 18 , 22 ]. Putz-Bankuti et al and Baur et al also observed that low levels of 25(OH)-vitamin D are associated with fibrosis and hepatic decompensation and death as well [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 92%

“…Our study findings are consistent with their study, where pre-treatment vitamin D levels were not associated with SVR 12. A key difference in our study is the higher SVR 12 rate of 94.5 % vs. SVR 12 rate of 78 % in their study [ 18 ]. Comparing SVR 12 between cirrhotics and non-cirrhotics groups, Backstedt et al reported cirrhotic patients had SVR 12 rates of 71% versus 96% in non-cirrhotic which is again higher in our study with SVR of 86.7% in cirrhotics vs. 94 % in non-cirrhotics.…”

Section: Discussionmentioning

confidence: 79%

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Association Between Vitamin D Levels and Treatment Response to Direct-Acting Antivirals in Chronic Hepatitis C: A Real-World Study

et al. 2018

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BackgroundLow serum vitamin D levels in chronic hepatitis C (CHC) is associated with advanced liver fibrosis; and there remains an imprecise relationship with the treatment response based on the vitamin D levels. Previous studies have shown conflicting results on the vitamin D levels, and association with treatment response in CHC treated with interferon-based regimens.MethodsPatients with CHC treated with direct-acting antivirals (DAAs) between January 2016 and December 2017 in the community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with the sustained virologic response at 12 weeks post-treatment (SVR 12) were assessed in CHC patients with deficient, insufficient, and normal levels of vitamin D measured before the initiation of DAA therapy.ResultsTwo hundred and ninety-one patients were included in the study. Direct-acting antivirals included in the study were ledipasvir/sofosbuvir ± ribavirin, ombitasvir + paritaprevir + ritonavir + dasabuvir ± ribavirin, and sofosbuvir/velpatasvir. An overall sustained virologic response was achieved in 95% (n = 276) of patients. SVR 12 rates among patients with vitamin D deficiency, vitamin D insufficiency and normal vitamin D levels were 92%, 96.2%, and 97.2% respectively and was not statically significant (P = 0.214). A total of 71 patients were cirrhotic. The prevalence of vitamin D insufficiency (20 - 29.9 ng/mL) and deficiency (< 20 ng/mL) was significantly higher in cirrhotic patients (P = 0.01). Despite this, pretreatment vitamin D levels did not show any impact on the virologic response. The most common adverse effect observed was fatigue. None of the patients had to discontinue the treatment due to adverse events.ConclusionsDAAs are safe and effective with a high overall SVR 12 in CHC and treatment response does not depend on the pretreatment vitamin D levels. The prevalence of both vitamin D insufficiency and deficiency was observed to be higher in cirrhotic cohorts compared to non-cirrhotic counterparts.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 79%

Association Between Vitamin D Levels and Treatment Response to Direct-Acting Antivirals in Chronic Hepatitis C: A Real-World Study

et al. 2018

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“…At the same time, seasonal and dietary factors were also not considered. A recent cohort study of 218 patients reported that serum vitamin D levels remained unchanged during direct-acting antiviral therapy (pre-treatment vs. post-treatment: 25.3 ± 15.9 vs. 26.4 ± 12.5, p = 0.10) [ 35 ]. In addition, this cohort study did not consider important variables such as seasonal factors [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of vitamin D supplements in patients with chronic hepatitis C: a randomized, multi-center, open label study

Jeong

Jun

Park

et al. 2020

Korean J Intern Med

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Background/Aims: We aimed to assess the role of vitamin D supplementation in the response to pegylated interferon-α (PEG-IFN-α) plus ribavirin (RBV) treatment in patients with chronic hepatitis C (CHC). Methods: Our study was a multi-center, randomized controlled trial in 11 hospitals. CHC patients were randomly assigned (1:1) to two groups namely, PEG-IFN-α plus RBV (control group) or PEG-IFN-α plus RBV + vitamin D (800 IU daily) (vitamin D group). The primary end-point was the rate of sustained virologic response (SVR). Results: One hundred forty eight CHC patients were randomly assigned to two groups. Seventy-one patients received the PEG-IFN-α plus RBV and 77 patients received the PEG-IFN-α plus RBV + vitamin D. A total of 105 patients completed the study (control group, 47 vs. vitamin D group, 58). Baseline characteristics were mostly similar in both the groups. There was a modest but non-significant increase in SVR in the vitamin D group compared to the control group with the intention to treat analysis (64.0% vs. 49.3 %, p = 0.071) as well as in the per protocol analysis (control group vs. vitamin D group: 74.5% vs. 84.5%, p = 0.202). Fifty-two patients (73.2%) in the control group and 63 patients (81.8%) in the vitamin D group experienced at least one adverse event. The drop-out rate due to adverse effects was not different between both groups (control group vs. vitamin D group: 19.7% vs. 10.4%, p = 0.111). Conclusions: Vitamin D supplement did not increase SVR in treatment naïve patients with CHC irrespective of genotype.

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“…In CHC, micronutrient deficiency is common, with deficiencies in zinc, vitamin A and vitamin D reported in up to 48.4%, 54.3% and 43% of patients, respectively [16,17,18]. Whilst micronutrient deficiencies may be mediated by HCV replication and associated inflammation, they may be further exacerbated by malnutrition due to lifestyle factors associated with chronic viral hepatitis [19].…”

Section: Introductionmentioning

confidence: 99%

The Role of Micronutrients in the Infection and Subsequent Response to Hepatitis C Virus

Gupta

Read

Shackel

et al. 2019

Cells

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Micronutrient deficiencies develop for a variety of reasons, whether geographic, socioeconomic, nutritional, or as a result of disease pathologies such as chronic viral infection. As micronutrients are essential for a strong immune response, deficiencies can significantly dampen both the innate and the adaptive arms of antiviral immunity. The innate immune response in particular is crucial to protect against hepatitis C virus (HCV), a hepatotropic virus that maintains chronic infection in up to 80% of individuals if left untreated. While many micronutrients are required for HCV replication, an overlapping group of micronutrients are also necessary to enact a potent immune response. As the liver is responsible for the storage and metabolism of many micronutrients, HCV persistence can influence the micronutrients’ steady state to benefit viral persistence both directly and by weakening the antiviral response. This review will focus on common micronutrients such as zinc, iron, copper, selenium, vitamin A, vitamin B12, vitamin D and vitamin E. We will explore their role in the pathogenesis of HCV infection and in the response to antiviral therapy. While chronic hepatitis C virus infection drives deficiencies in micronutrients such as zinc, selenium, vitamin A and B12, it also stimulates copper and iron excess; these micronutrients influence antioxidant, inflammatory and immune responses to HCV.

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25-Vitamin D levels in chronic hepatitis C infection: association with cirrhosis and sustained virologic response

Cited by 15 publications

References 24 publications

Association Between Vitamin D Levels and Treatment Response to Direct-Acting Antivirals in Chronic Hepatitis C: A Real-World Study

Association Between Vitamin D Levels and Treatment Response to Direct-Acting Antivirals in Chronic Hepatitis C: A Real-World Study

Effects of vitamin D supplements in patients with chronic hepatitis C: a randomized, multi-center, open label study

The Role of Micronutrients in the Infection and Subsequent Response to Hepatitis C Virus

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