Abstract

Background: The aim of the study was to investigate the change in serum vitamin D levels in patients who achieved sustained viral response by treatment with DAA.

Material and Method: Between June 2016 and June 2018, 107 patients with chronic hepatitis C treated with direct-acting antivirals were included in this study. Pre-treatment, post-treatment and control groups were analyzed for serum vitamin D levels. The effect of sustained viral response of Chronic Hepatitis C on vitamin D levels was evaluated.

Results: The prevalence of vitamin D insufficiency (20 - 30 ng/mL) and deficiency (< 20 ng/mL) were 13% and 60.7% in patients with Chronic Hepatitis C, respectively. Considering patients with low serum vitamin D, the mean serum vitamin D level before treatment was 22.9 ± 19.9 ng/dl, whereas the mean serum vitamin D level after treatment was 25.3 ± 17.7 ng/dl and was statistically significant increased (p < 0.001).

Conclusion: The prevalence of vitamin D deficiency is high in patients with Chronic Hepatitis C. Vitamin D levels may increase with direct-acting antiviral treatment, particularly in patients with Vitamin D deficiency and insufficiency.

Keywords: Chronic Hepatitis C; Vitamin D; Direct Acting Antivirals

References

1. Holick MF. “Vitamin D deficiency”. The New England Journal of Medicine 357 (2007): 266-281.
2. Wesley Pike J and Shevde NK. “The vitamin D receptor”. In: Feldman D, Wesley Pike J, Glorieux FH editor(s). Vitamin D. 2^nd Amsterdam (Netherlands): Els Academic Press (2005):167-191.
3. Kovesdy Csaba P and Quarles LD. “Fibroblast growth factor- 23: what we know, what we don’t know, and what we need to know”. Nephrology Dialysis Transplantation 9 (2013): 2228-2236.
4. Holick MF., et al. “Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline”. The Journal of Clinical Endocrinology and Metabolism 96 (2011): 1911-1930.
5. Gal-Tanamy M., et al. “Vitamin D: an innate antiviral agent suppressing hepatitis C virus in human hepatocytes”. Journal of Hepatology 54 (2011): 1570-1579.
6. Lange CM., et al. “Vitamin D receptor and Jak-STAT signaling crosstalk results in calcitriol-mediated increase of hepatocellular response to IFN-α”. Journal of Immunology 192 (2014): 6037-6044.
7. Matsumura T., et al. “25-Hydroxyvitamin D3 suppresses hepatitis C virus production”. Journal of Hepatology 56 (2012): 1231-1239.
8. Petta S., et al. “Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronichepatitis C”. Journal of Hepatology 51 (2010): 1158-1167.
9. García-Álvarez M., et al. “Relationship of vitamin D status with advanced liver fibrosis and response to hepatitis C virus therapy: a meta-analysis”. Journal of Hepatology 60 (2014): 1541-1550.
10. Avihingsanon A., et al. “Advanced liver fibrosis by transient elastography, fibrosis 4, and alanine amino transferase/platelet ratio index among Asian hepatitis C with and without human immuno deficiency virus infection: role of vitamin D levels”. Journal of Gastroenterology and Hepatology 29 (2014): 1706-1714.
11. Backstedt D., et al. “25-Vitamin D levels in chronic hepatitis C infection: association with cirrhosis and sustained virologic response”. Annals of Gastroenterology 3 (2017): 344-348.
12. Caprio M., et al. “Vitamin D: not just bone. Evidence for pleiotropic extra skeletal effects”. Eating and Weight Disorders 22 (2016): 27-41.
13. Hewison M. “Antibacterial effects of vitamin D”. Nature Reviews Endocrinology 7 (2011): 337-345.
14. Mangin M., et al. “Inflammation and vitamin D: the infection connection”. Inflammation Research 63 (2014): 803-819.
15. Yousif MM., et al. “Associated vitamin D deficiency is a risk factor for the complication of HCV-related liver cirrhosis including hepatic encephalopathy and spontaneous bacterial peritonitis”. Internal and Emergency Medicine 5 (2019): 753-761.
16. Lips P. “Worldwide status of vitamin D nutrition”. Journal of Steroid Biochemistry and Molecular Biology 1-2 (2010): 297-300.
17. Lips P. “Vitamin D physiology”. Progress in Biophysics and Molecular Biology 1 (2006): 4-8.
18. Iruzubieta P., et al. “Vitamin D deficiency in chronic liver disease”. World Journal of Gastroenterology 6 (2014): 901-915.
19. Gayam V., et al. “Association Between Vitamin D Levels and Treatment Response to Direct-Acting Antivirals in Chronic Hepatitis C: A Real-World Study”. Gastroenterology Research 4 (2018): 309-316.