Vitamin A deficiency is associated with hepatitis C virus chronic infection and with unresponsiveness to interferon-based antiviral therapy

Abstract

Recent data suggest that vitamin A modulates the expression of type I interferon receptor enhancing the antireplication effect of interferon-a on hepatitis C virus (HCV). This study aimed to investigate the prevalence of vitamin A deficiency among patients with chronic HCV infection and to assess whether vitamin A deficiency could be associated with unresponsiveness to interferon-based antiviral therapy. The analysis included 199 consecutive treatment-naïve chronic HCV patients in whom pretreatment serum vitamin A and 25-OH vitamin D were measured; 119 healthy blood donors were used as controls. Median (interquartile range) serum vitamin A in HCV-positive patients was significantly lower than in controls: 256 ng/mL (128-440) versus 742 (624-942, P < 0.0001). Overall sustained viral response was achieved in 122/199 patients, 46/109 infected by difficult to treat HCV genotypes. In these latter, 39/104 (37.5%) were nonresponders. At multivariate analysis, nonresponse to antiviral therapy was predicted by carriage of interleukin (IL)-28B T/* genotypes, baseline serum levels of cGT >60 IU/mL, of HCV RNA >600,000 IU/mL, of vitamin A 100 ng/mL, and a cumulative dose of ribavirin 80%. Seventeen patients (9.0%) had both serum levels of vitamin A 100 ng/mL and of vitamin D 20 ng/mL; the presence of a combined vitamin A and D deficiency was found to be a strong independent predictor of nonresponse to antiviral therapy. Conclusion: A high percentage of patients with chronic HCV infection have serum vitamin A deficiency. This condition is associated with nonresponse to antiviral therapy. (HEPATOLOGY 2013;00:000-000)

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…As quiescent stellate cells become activated, they lose their vitamin A stores and are then capable of producing collagen and subsequent fibrosis. Vitamin A deficiency has been reported in patients with hepatitis C-related chronic liver disease 21,22 and is associated with non-response to antiviral therapy. 22 Vitamin A deficiency is also present in approximately 50% of patients with alcoholic cirrhosis 21,23 and patients with chronic alcoholism have been shown to have very low concentrations of hepatic vitamin A at all stages of their disease.…”

“…Vitamin A deficiency has been reported in patients with hepatitis C-related chronic liver disease 21,22 and is associated with non-response to antiviral therapy. 22 Vitamin A deficiency is also present in approximately 50% of patients with alcoholic cirrhosis 21,23 and patients with chronic alcoholism have been shown to have very low concentrations of hepatic vitamin A at all stages of their disease. 24 The presence of HE, a complex neuropsychiatric complication associated with liver disease, is associated with reduced serum retinol levels.…”

GC Gene Polymorphism and Unbound Serum Retinol-Binding Protein 4 Are Related to the Risk of Insulin Resistance in Patients With Chronic Hepatitis C

“…Retinol binding protein 4 transports 95% of serum retinol 37 and both parameters are strongly correlated (r = 0.884 in our study). Hence, the serum level of retinol strictly depends on the hepatic synthesis and excretion of RBP4, that, in turn, decreases in parallel to increasing liver damage 38–40 and inflammation. 41 It has been suggested that a retinol-to-RBP4 ratio <0.8 reflects retinol deficiency better than serum retinol level.…”

Reply

“…[2][3][4] However, these studies were published by prestigious journals during consecutive years and provided independent and remarkable information, each of them including a different number of patients. Nevertheless, the significant association was lost if we reanalyzed it considering only one of these studies.…”