Effect of vitamin D supplementation on sustained virological response in genotype 1/4 chronic hepatitis C treatment-naïve patients from India

Abstract

Background & objectives:The effect of vitamin D supplementation on response to antiviral therapy in hepatitis C virus (HCV) genotype 1 and 4 infection still remains unclear, with studies yielding inconsistent results. The aim of the present study was to assess the effect of vitamin D supplementation on treatment outcome in patients with genotype 1/4 chronic hepatitis C (CHC) infection.Methods:Sixty consecutive, treatment-naïve, genotype 1 and 4 chronic HCV patients were included in the study. The patients were randomized into two groups: Vitamin D supplemented group received pegylated (PEG)-interferon α-2a 180 μg per week plus ribavirin (RBV) (1000-1200 mg/d) together with vitamin D3 (2000 IU/d) and control group received identical therapy without vitamin D (32 patients).Results:There were no significant differences between the two groups in terms of age, sex, body mass index and baseline laboratory values. Lower vitamin D levels were associated with higher grades of fibrosis in liver histology (vitamin D >20 ng/ml - 70% vs vitamin D <20 ng/ml - 37%, P<0.05). Vitamin D supplemented group had similar rapid viral response (40 vs 28%, P=0.36), complete early viral response (53.2 vs 40%, P=0.34), end of treatment response (64 vs 46%, P=0.17) and sustained virological response (SVR) (60 vs 44%, P=0.19) as compared to control group. Interleukin 28B polymorphism [odds ratio (OR)-15.37, 95% confidence interval (CI)-2.32-101.76, P=0.04] and baseline serum vitamin D levels (OR-6.36, 95% CI-1.36-29.61 P=0.02) were independent predictors of SVR in genotype 1/4 CHC. Vitamin D supplementation was not found to be predictor of response in genotype 1/4 CHC on multivariate analysis (OR-2.79, 95% CI- 0.63-12.34, P=0.74).Interpretation & conclusions:The present study showed that addition of vitamin D to PEG/RBV combination therapy in treatment-naïve patients who were infected with HCV genotype 1/4 had no effect on the rates of rapid, early and sustained viral responses.

Controversial Effects of Vitamin D and Related Genes on Viral Infections, Pathogenesis, and Treatment Outcomes

“…Chronic liver inflammation and the subsequent progression to liver cirrhosis and hepatocellular carcinoma (HCC) are typical clinical symptoms of chronic HCV infection. A significant inverse relationship between the severity of inflammatory fibrosis and cirrhosis and serum 25(OH)D 3 levels was observed in HCV patients [32,33,37,40,[62][63][64]. This implies VD deficiency as an independent predictor and risk factor for inflammatory liver complications in HCV patients [38,39,[65][66][67].…”

“…Several researchers reported a positive correlation between VD status and sustained virological response (SVR) rates to this standard PEG-IFNα/ribavirin therapy for HCV patients [34,48,51,52,66]. Therefore, VD deficiency was regarded as a potential predictor of an unfavorable response to IFNα-based HCV treatment [45,46,50,64]. In line with this, VD supplementation improved the probability of achieving an SVR following antiviral treatment [37,45,46,49,51,[69][70][71].…”

Relationship of serum vitamin D with hepatic fibrosis in patients with chronic hepatitis C

“…20 One of our previous study from Varanasi also revealed the negative association of vitamin D level with stage of fibrosis. 21 The relation of vitamin D with stage of fibrosis could be attributable to anti-inflammatory activity of vitamin D, recruitment of less inflammatory cells leading to less fibrosis. 22 Among the risk factors for HCV acquisition, blood transfusion was the most common occurring in one third of patients followed by IVDU and iatrogenic procedures.…”

Vitamin D, zinc and glutamine: Synergistic action with OncoTherad immunomodulator in interferon signaling and COVID‑19 (Review)

“…Several clinical trials have indicated that vitamin D3 supplementation (1,000 or 2,000 IU/day) is effective for enhancing the efficacy of antiviral treatment with pegylated interferon and ribavirin (PEG-IFN/RBV) in patients with hepatitis C (120-123). Conversely, low serum concentrations of the hormone seem to be related to severe hepatic fibrosis and/or to the lower responsiveness to treatment with PEG-IFN/RBV (124,125).…”