Vitamin D supplementation improves sustained virologic response in chronic hepatitis C (genotype 1)-naïve patients

Abu-Mouch, Saif; Fireman, Zvi; Jarchovsky, J; Zeina, Abdel-Rauf; Assy, Nimer

doi:10.3748/wjg.v17.i47.5184

Cited by 180 publications

(177 citation statements)

References 26 publications

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“…Further, vitamin D deficiency was associated with several immunemediated diseases and increased susceptibility to infection and cancer (Holick and Chen, 2008;Lange et al, 2009). Recently, vitamin D insufficiency (defined as 25-hydroxy-vitamin D serum level of 20-29 ng/ml) has been proposed as a predictor of failure of treatment of chronic hepatitis C with PEG-IFNa and ribavirin (Abu Mouch et al, 2011;Petta et al, 2010). Moreover, severe vitamin D deficiency (defined by a 25-hydroxy-vitamin D serum level 520 ng/ml) is a common feature of chronic hepatitis C, even in the absence of advanced liver fibrosis (Lange et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Circulating IL-6, IL-17 and vitamin D in hepatocellular carcinoma: Potential biomarkers for a more favorable prognosis?

Hammad¹,

Abdelraouf²,

Hassanein

et al. 2013

Journal of Immunotoxicology

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Hepatitis C virus (HCV) infects primarily hepatocytes, leads to development of fibrosis and/or cirrhosis of the liver and is a significant factor for developing hepatocellular carcinoma (HCC). Evidence indicates that liver fibrosis contains uncontrolled inflammation as a part of its etiology. Normal cell-mediated immunity plays a central role in the mechanisms involved in viral clearance/persistence in the liver. In this context, cytokines modulate the immune system and exert direct anti-viral activity. To this end, this study investigated potential associations of serum IL-17 and IL-6 with exacerbation of hepatic damage in chronic HCV patients to determine their utility as prognostic markers for potential development of HCC. Chronic HCV-patients were recruited, divided into groups according to degree of liver damage, i.e. patients with perihepatic fibrosis, hepatic cirrhosis, or HCC, and had their blood collected for analysis of liver function and serum IL-6 and IL-17 levels. Interestingly, increases in serum IL-17 levels in the study groups were associated with aggravation of the clinical state from HCV to cirrhosis and then to HCC. Serum IL-6 levels followed a similar pattern. The association of both cytokines with progressive exacerbation of the initial HCV-induced liver damage was further confirmed by correlation analysis that revealed positive correlations between HCV RNA titer and IL-17 (þ0.951, p50.05) and IL-6 (þ0.85, p50.05). A receiver operating characteristics (ROC) analysis revealed their beneficial addition as promising biomarkers for a better prognostic profile of HCC. Interestingly, a significant progressive decline in the active vitamin D status was noted in all three clinical states, and these too were associated with progressive liver disease. This study confirms the necessity of adding screening for IL-6 and IL-17 and vitamin D to that of the classic marker AFP for patients with HCV and cirrhosis to hopefully permit clinicians to initiate measures that ultimately might mitigate/delay development of HCC in these infected patients.

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Section: Discussionmentioning

confidence: 99%

Circulating IL-6, IL-17 and vitamin D in hepatocellular carcinoma: Potential biomarkers for a more favorable prognosis?

Hammad¹,

Abdelraouf²,

Hassanein

et al. 2013

Journal of Immunotoxicology

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“…Recent in vitro studies have shown that VD acts as an antiviral agent that inhibits hepatitis C virus (HCV) production in a human hepatoma cell line (DiCarlo et al, 2015). In patients with HCV that underwent OLT with subsequent recurrent HCV, high rates of sustained virologic response (SVR) were noted in patients receiving VDS (Abu-Mouch, Fireman, Jarchovsky, Zeina, & Assy, 2011;Bitetto et al, 2011;Iruzubieta et al, 2014).…”

Section: Sustained Virologic Responsementioning

confidence: 99%

A vitamin D protocol post‐liver transplantation

Grant

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Adults with compromised liver function are inherently deficient and especially vulnerable to the consequences of vitamin D deficiency. Consequences of vitamin D deficiency include liver disease progression, infection, and graft failure. A vitamin D supplementation protocol is proposed to systematically optimize serum vitamin D levels according to guidelines in both pre‐ and post‐liver transplanted patients. Methods This quasiexperimental study included a sample of N = 45 post‐liver transplanted patients taking daily cholecalciferol (vitamin D3) 2500 units for 12 weeks, with a pre‐ and post‐lab measure of serum 25‐hydroxyvitamin D levels at a large academic facility. Conclusions Seventy‐eight percent of patients reached minimum guideline levels using the protocol with an average increase of serum vitamin D of 13.8 ng/mL. Long‐term outcomes of clinical significance may include decreased incidence of acute T‐cell‐mediated graft rejection and infections in the immunocompromised patient. Implications for practice Optimizing vitamin D in vulnerable patient populations such as chronic liver disease and the immunosuppressed posttransplanted patient has the potential to curtail complications of vitamin D deficiency. As a result, nurse practitioners employing a vitamin D protocol can create a favorable impact on patient quality of life, safety, and healthcare spending.

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“…Another predictor of response to PEGIFN/RBV therapy was found to be insulin resistance, which impairs response rates to PEG IFN/RBV therapy in HCV GT4 patients, and patients with Homeostasis Model Assessment for Insulin Resistance scores > 2 had lower SVR rates than those with scores < 2 (36% vs 72%) [147] . AbuMouch et al [148] found that adding vitaminD to the standard of care with PEGIFN/RBV therapy for HCVGT1 infected patients increases SVR rates from 42% to 82%. Esmat et al [149] reported that vitamin D supplementation, despite its role in other GTs, has no positive impact on treatment outcome in HCVGT4 patients where SVR was achieved in 51.2% in group 2, [who received the standard of care therapy (SOC .…”

Section: Background In Hcv Treatmentmentioning

confidence: 99%

Hepatitis C genotype 4: The past, present, and future

Abdel-Ghaffar

Sira

Naghi

2015

WJH

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Hepatitis C virus (HCV) genotype (GT) 4 represents 12%-15% (15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Europe. GT-4 (and subtype 4a in particular) dominates the HCV epidemic in Egypt. In underdeveloped countries, risk factors associated with HCV infection may be due to unsafe medical practices or other factors such as familial transmission, mother's HCV status, or illiteracy. HCV prevention and control programs should include health education, increased community awareness towards the disease, controlling infection distribution in healthcare centers, proper sterilization of medical and dental instruments, and ensuring safe supply of blood and blood-products. Response rates to a 48-wk combined pegylated-interferon (PEG-IFN) and ribavirin (RBV) treatment range from 40%-69%, and HCV-GT-4 has been considered better than GT-1 but worse than GT-2 and GT-3 in treatment with PEG-IFN/RBV. However, with the introduction of the HCV-GT-1 effective protease inhibitors boceprevir and telaprevir in 2011, HCV-GT-4 became the "most difficult (GT) to treat". Recently, the direct-acting antivirals (DAAs) with pan-genotypic activities simeprevir, sofosbuvir, and daclatasvir have been recommended in triple regimens with PEG-IFN/RBV for the treatment of HCV-GT-4. An IFN-free regimen will be available for treatment of all genotypes of HCV in the near future. To date, several DAAs have been developed and are currently being evaluated in various combinations in clinical trials. As new regimens and new agents are being approved by the Food and Drug Administration, we can expect the guidelines for HCV treatment to be changed. The availability of shorter, simpler, and more tolerable treatment regimens can reduce the morbidity and mortality associated with HCV infection. With such a large number of therapeutic agents available, we can end up with a range of choices that we can select from to treat patients.

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Vitamin D supplementation improves sustained virologic response in chronic hepatitis C (genotype 1)-naïve patients

Abstract: Adding vitamin D to conventional Peg-α-2b/ribavirin therapy for treatment-naïve patients with chronic HCV genotype 1 infection significantly improves the viral response.

Cited by 180 publications

References 26 publications

Circulating IL-6, IL-17 and vitamin D in hepatocellular carcinoma: Potential biomarkers for a more favorable prognosis?

Circulating IL-6, IL-17 and vitamin D in hepatocellular carcinoma: Potential biomarkers for a more favorable prognosis?

A vitamin D protocol post‐liver transplantation

Hepatitis C genotype 4: The past, present, and future

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