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

Abstract

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.

Evaluation of Direct Acting Antiviral Agents in the Treatment of Patients With Chronic Hepatitis C Infection in Alexandria

“…This may be explained by low nutritional status of the patients during the course of therapy and as a side effect of combination treatment of SOF and RBV. In agreement, Gayam et al, (2018) [38] found an association between DAAs administration and decreased hemoglobin level. Chang et al, (2017) [39] in their study on DAAs therapies for CHC among Asian Americans to evaluate SVR and adverse events, found that anemia was highest in patients receiving SOF/RBV.…”

Prevalence of Vitamin-D deficiency is related to severity of liver damage in Hepatitis-C patients

“…Vitamin-D deficiency may also lead towards increased viral load, increased inflammation and damage to liver. 16 However Vidot and colleagues reported that Vitamin-D insufficiency was not associated with chronic liver diseases and complications. 17 his team didn't find any substantial differences in serum 25 (OH) D3 and Vitamin-D binding protein (DBP) levels between HCV and healthy controls.…”

Role of Serum Vitamin D, Interleukin 13, and microRNA-135a in Hepatocellular Carcinoma and Treatment Failure in Egyptian HCV-Infected Patients Receiving Direct Antiviral Agents

“…Vitamin D, along with IFN-α, enhances gene expression, leading to HCV clearance in vivo. In contrast, one study reported that treatment response with DAAs does not depend on the pretreatment vitamin D levels [ 86 ]. Additionally, higher vitamin D status was not beneficially associated with responses to therapy; if anything, patients with higher vitamin D concentrations were less likely to attain SVR and do not support a role for vitamin D supplementation as an adjuvant therapy for HCV [ 87 ].…”