Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 28, 2012; 18(8): 800-805
Published online Feb 28, 2012. doi: 10.3748/wjg.v18.i8.800
Vitamin D improves viral response in hepatitis C genotype 2-3 naïve patients
Assy Nimer, Abu Mouch
Assy Nimer, Department of Liver, Ziv Medical Center, Safed 13100, Israel
Abu Mouch, Department of Liver, Hillel Yaffe Medical Center, Hadera 38100, Israel
Assy Nimer, Abu Mouch, Faculty of Medicine, Technion, Haifa 32000, Israel
Author contributions: Nimer A and Mouch A contributed equally to this work; Nimer A designed the research and wrote the paper; Mouch A designed the research and revised the paper.
Correspondence to: Assy Nimer, MD, Associate Professor, Department of Liver, Ziv Medical Center, Safed 13100, Israel. assy.n@ziv.health.gov.il
Telephone: +972-4-6828442 Fax: +972-4-6828441
Received: February 6, 2011
Revised: April 19, 2011
Accepted: April 26, 2011
Published online: February 28, 2012
Abstract

AIM: To examine whether vitamin D improved viral response and predicted treatment outcome in patients with hepatitis C virus (HCV) genotype 2-3.

METHODS: Fifty patients with chronic HCV genotype 2-3 were randomized consecutively into two groups: Treatment group [20 subjects, age 48 ± 14 years, body mass index (BMI) 30 ± 6, 65% male], who received 180 μg pegylated α-interferon-2a plus oral ribavirin 800 mg/d (Peg/RBV), together with oral vitamin D3 (Vitamidyne D drops; 2000 IU/d, 10 drops/d, normal serum level > 32 ng/mL) for 24 wk; and control group (30 subjects, age 45 ± 10 years, BMI 26 ± 3, 60% male), who received identical therapy without vitamin D. HCV RNA was assessed by reverse transcription polymerase chain reaction. Undetectable HCV RNA at 4, 12 and 24 wk after treatment was considered as rapid virological response, complete early virological response, and sustained virological response (SVR), respectively. Biomarkers of inflammation were measured.

RESULTS: The treatment group with vitamin D had higher BMI (30 ± 6 vs 26 ± 3, P < 0.02), and high viral load (> 400 000 IU/mL, 65% vs 40%, P < 0.01) than controls. Ninety-five percent of treated patients were HCV RNA negative at week 4 and 12. At 24 wk after treatment (SVR), 19/20 (95%) treated patients and 23/30 (77%) controls were HCV RNA negative (P < 0.001). Baseline serum vitamin D levels were lower at baseline (20 ± 8 ng/mL) and increased after 12 wk vitamin D treatment, to a mean level of (34 ± 11 ng/mL). Logistic regression analysis identified vitamin D supplement [odds ratio (OR) 3.0, 95% CI 2.0-4.9, P < 0.001], serum vitamin D levels (< 15 or > 15 ng/mL, OR 2.2, P < 0.01), and BMI (< 30 or > 30, OR 2.6, P < 0.01) as independent predictors of viral response. Adverse events were mild and typical of Peg/RBV.

CONCLUSION: Low vitamin D levels predicts negative treatment outcome, and adding vitamin D to conventional Peg/RBV therapy for patients with HCV genotype 2-3 significantly improves viral response.

Keywords: Hepatitis C; Genotype 2-3; Vitamin D; Sustained viral response; Peg-interferon alpha 2a