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Importance of Vitamin D Levels
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Importance of Vitamin D Levels

Hello again everyone...I recently completed my 12th week with shot #13 coming tonight. I was undetectable at week 4 so im pleased to be responding well. I have also had very mild side effects but have apparently started the riba rash tonight.  I've been clawing myself to death until I realized what it was, lol.

I saw a new hematologist last week that sincerely believes theres a relationship between vitamin D levels and response to therapy. Anyone one else know of or heard this before?  Any suggestions on controlling the itching would be most helpful as well.

Thanks!
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1658980_tn?1330715150
I read an article the other day about a study regarding Vit D levels and treatment success.  The study was small but it did show a correlation.  I take 4000 IU a day and am considering upping it by another 2000.  
Sorry that I can't help with the rash/itch - it hasn't hit me yet.  I did see a thread on here in the last day or so about things that work.  
Good luck and congrats on your successful response.  I'm in my third week of treatment - my first week tests showed an enormous drop in VL so hopefully I'm on the same path.
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Avatar_f_tn
There have been a number of threads here about Vitamin D in relation to HCV.  If you do a search on

Vitamin D HCV

It will bring up some of those threads.  Likely other searches as well.  

There's a Gold Bond thread at the moment on itching...you might want to post separately on the itching issue, you'll definitely get responses on that.  Good luck to you!

Trish
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Avatar_f_tn
Should have said...for myself, I ended up using cortisone cream.  Drove me crazy for awhile.  Others will have other and likely better suggestions, that gave me temporary relief in sensitive areas.

Trish
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Avatar_m_tn
For the itching:

Gold bond extra strength lotion is good. Also ask your doctor for a prescription for Atarax.
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720656_tn?1311043835
The itching drove me crazy too. I ended up with a massive break out on my back where it was hard for me to keep moisturized. I started with Gold Bond (green bottle w/red cap) but I switched to Eucerin Calming Creme. I felt the Eucerin helped more for me and it was also more thick and creamy. Also staying well hydrated helps too! Water water water.

I had been taking Vit D for years prior to treatment and continued throughout. There were several posts concerning this topic here. Also my trial nurse asked about by Vit D usage but did not elaborate on the subject. I was still UND at four weeks post treatment. I go next week for my twelve week and will post the results when I receive them.

Good luck with your rash : )
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Avatar_n_tn
Triamcinolone ointment (Rx) for the rash.  Worked like a champ for me.  
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Avatar_m_tn
The Vitamin D study was a small study done in Israel . The SVR rates are as good as those with Teleprevir . Here it is.

Session Title: Parallel Session: HEPATITIS C: CLINICAL ADVANCES AND THERAPY
Presentation Date: Apr 16, 2010
VITAMIN D SUPPLEMENT IMPROVE SVR IN CHRONIC HEPATITIS C (GENOTYPE 1) NAïVE PATIENTS TREATED WITH PEG INTERFERON AND RIBAVIRIN
S. Abu Mouch1,2, Z. Fireman1,2, J. Jarchovsky1,2, N. Assy2,3
1Hepatology Unite, 2Internal Medicine B, Hillel Yaffe Medical Center, Hadera, 3Faculty of Medicine, Technion, Haifa, 4Gastroenterology, Hillel Yaffe Medical Center, Hadera, 5Liver Unit, Ziv Medical Center, Safed, Israel. ****@****

Background: The combination therapy of Peg/RBV is considered the standard of care for chronic hepatitis C (HCV). A sustained viral response (SVR) is obtained in 40-50% of naïve HCV patients with genotype 1. Vitamin D is a potent immuno modulator whose impact on SVR of Peg/RBV based treatment of chronic HCV is unknown.
Aim: To assess whether the supplement of vitamin D to the conventional Peg/RBV therapy could improve SVR.
Methods: Fifty-eight patients with chronic HCV infection were randomized into two groups (intent-to-treat population): 27 (treatment group, age 47±11 yrs, body mass index [BMI] 27±4, 50% male) received pegylated-interferon-alpha2b (1.5 µg/kg once weekly) plus ribavirin (1000-1200 mg/daily) together with vitamin D3 (1000-4000 IU/daily, serum level >32 ng/ml), and 31 (controls, age 49±7 years, BMI 24±3, 60% male) received the same therapy without vitamin D. HCV RNA was assessed by RT-PCR (sensitivity, 50 IU/mL). Undetectable HCV RNA at week 12 and at week 24 post treatment (considered as complete EVR and SVR respectively).
Results: Demographics, disease characteristics, ethnicity, baseline biochemical parameters and adherence to treatment were similar in both groups. The treatment group had a higher mean BMI (27±4 vs 24±3; P< 0.01), viral load (68% vs 58%, PF2: 55% vs 18%, P< 0.001) than the controls. All but one treated patient (96%) and 48% (15/31) controls were HCV-RNA negative at week 12 (P< 0.0001). At week 24 post treatment (SVR): 86% (13/15) of treated patients and 41% (5/12) of controls were HCVRNA negative (P< 0.001). AEs were mostly mild and typical of Peg/RBV. There were no SAE.
Conclusions: Supplement of Vitamin D to conventional Peg/RBV therapy for naïve, genotype 1 patients with chronic infection significantly improve SVR

Benefits of Vitamin D
A low vitamin D level is associated with more severe liver fibrosis and poor treatment response, according to a study published in the April 2010 Hepatology and supporting research presented at the April meeting of the European Association for the Study of the Liver (EASL). Prior research indicates that vitamin D is an immune modulator that influences inflammatory responses and fibrogenesis (fibrosis formation); it may also improve insulin sensitivity and even inhibit HCV replication.
S. Petta and colleagues from Italy looked at the link between vitamin D and response to interferon-based therapy among 197 genotype 1 chronic hepatitis C patients (85% of whom were treated with pegylated interferon plus ribavirin) and 49 healthy HCV negative control subjects. They measured serum levels of 25-hydroxyvitamin D and tissue expression of two liver enzymes (CYP27A1 and CYP2R1) that process vitamin D.
Average serum vitamin D levels were significantly lower in hepatitis C patients compared with control subjects (25.07 vs. 43.06 mcg/L). Women on average had lower vitamin D levels than men, and people with hepatic necroinflammation had lower levels than those with healthy livers. Levels of CYP27A1 (but not CYP2R1) were directly correlated with vitamin D levels. After adjusting for other factors, low vitamin D was an independent predictor of severe liver fibrosis or cirrhosis (stage F3-F4). Overall, 41% of patients achieved SVR; a low vitamin D level was likewise an independent predictor of poor treatment response.
In the study presented at EASL, S. Abu Mouch and colleagues from Israel evaluated whether vitamin D supplements would improve the likelihood of sustained response to hepatitis C therapy. In an initial analysis of 157 genotype 1 chronic hepatitis C patients treated at their clinic, fully 84% had low vitamin D levels and one-third had severe deficiency. Then, in a randomized study, 67 patients were treated with pegylated interferon alfa-2b (PegIntron) plus ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3.
At 4 weeks, 44% of participants receiving vitamin D supplements achieved rapid virological response, compared with just 18% in the unsupplemented group. SVR rates were likewise significantly higher in the vitamin D group, 85% vs. 43%, respectively. People with dark skin produce less vitamin D when exposed to the sun and are more likely to be deficient, leading the researchers to suggested that vitamin D deficiency might contribute to the well-known strong racial/ethnic disparities in interferon response rates
Learning from the setbacks of hepatitis B and HIV treatment, researchers understand the benefits of using STAT-C agents in combination regimens from the outset, rather than adding additional drugs after resistance develops.  Given how quickly resistance can emerge, the U.S.  Food and Drug Administration now limits clinical trials of direct antiviral agents to three days of monotherapy.
Several studies have demonstrated that combining HCV protease inhibitors with pegylated interferon/ribavirin delays the emergence of resistance.  In the PROVE trials, however, about 25% of participants who took telaprevir plus pegylated interferon without ribavirin developed resistance.  Some trials start with a pegylated interferon/ribavirin “lead-in” period to drive down viral load before adding the direct antiviral agent.
Researchers are exploring combinations of STAT-C agents that work by different mechanisms in the hope of one day eliminating pegylated interferon/ribavirin.  In the first such clinical trial (INFORM-1), presented last fall at the 2009 annual meeting of the American Association for the Study of Liver Diseases (AASLD), S. Le Pogam and colleagues showed that over 14 days, the protease inhibitor RG7227 plus the polymerase inhibitor RG7128 produced potent antiviral activity.  Viral load declined by as much as 5 logs and no resistant mutations were detected, even in one patient in a low-dose arm who experienced viral breakthrough.
Using another novel approach, L. Delang and colleagues recently demonstrated that adding statin drugs (usually used to manage high cholesterol) to HCV protease and polymerase inhibitors enhanced antiviral activity and reduced emergence of resistant mutations.

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Wow-thanks for the info.  I have been taking Vit D for several years and have attributed a lot of my good health and immune system to it (including fighting SAD during the winter months).  I'm glad I have been taking it and am going to up my dose by 1000 IU now that I'm in treatment.  Can't hurt.
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Avatar_m_tn
Thanks so much for the information and motivation. I spoke to my doctor today and we're going to decrease ribv and an Atarax rx. My Vit D levels were low so we are going to do 8 weeks of Vit D as well.

We'll see how the itch goes.

Researchmonkey326 and Gee704 - Best of luck to you both in your upcoming labs. I'm sure you'll do well. ;0)
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446474_tn?1385271190
You have already responded to therapy (RVR) so vitamin D deficiency (if you are deficient) is not an issue with you. But this is something a person thinking about HCV treatment can have tested for and correct before starting treatment. In a similar manner I person can have the IL28B test performed to give them a estimate of the odds of SVR before starting treatment.

I was tested and my results were 12 ng/mL. Meaning vitamin D deficiency. (This is common in cirrhotics as the Israeli study indicated).
Vit D excess:  > 150 ng/mL
Vit D sufficiency:  > 30 ng/mL
Vit D insufficiency:  10 - 30 ng/mL
Vit D deficiency:  < 10 ng/mL
I was told by my hepatologist to take 5000 I.U. of liquid softgel to correct this problem.

Too much vitamin D as well as certain vitamins and supplements can be harmful to your liver depending on how healthy your liver is. Vitamins A, D, E and K are fat-soluble (dissolve in fat) and should not be taken in doses higher than the USDA recommended daily allowance. These fat-soluble vitamins are stored in the liver so when taken in higher than recommended doses, they can become harmful to the liver.

Good luck and success with your treatment!
Cheers!
Hectorsf
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Avatar_f_tn
Hi there - just wanted to make sure I read this right:

"I spoke to my doctor today and we're going to decrease ribv and an Atarax rx. "

To be clear, you and your doctor have agreed to reduce your ribavirin?  You are in your 13th week of treatment and UND at Week 4 - I'd really question a dose reduction in your ribavirin at this point.  You are Genotype 1?  Actually it wouldn't matter what genotype you are when dose reducing at Week 13 - that's pretty early in the game to be going for a dose reduction over a rash - I don't know how bad it is but I'd seriously consider keeping dosage the same and trying other methods to combat that rash first.  Dose reduction would be a very last resort.  

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