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Vit D for HCV from EASL
This is a very interesting article from HCV Advocate. It shows an incredible 85 per cent SVR from SOC and Vitamin D. Thats better than Teleprevir!! I doubt I will treat again until I can add a PI, but I would be very tempted to add Vit D at the dose that this study did.
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.
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.
thanks - it seems recommendations for desirable serum vit D have been on the upswing. 30ng/ml (equivalent to 75 nmol/L) in fact seems at the low-end of recommended healthy range with benefits to being somewhat higher
http://www.ncbi.nlm.nih.gov/pubmed/19945690
http://cme.medscape.com/viewarticle/541149
strange that in the Mouch study they didn't release the actual serum levels obtained after supplements
http://www.ncbi.nlm.nih.gov/pubmed/19945690
http://cme.medscape.com/viewarticle/541149
strange that in the Mouch study they didn't release the actual serum levels obtained after supplements
I asked a friend that is pretty up on the vit D thing and he sent me this: LabCorp does ng / ml reference (32-100)
Do you remember HR saying that Lab Corp was the first to raise the upper level?
Best wishes,
Ev
Do you remember HR saying that Lab Corp was the first to raise the upper level?
Best wishes,
Ev
the Mouch EASL presentation is here:
http://www.kenes.com/easl2010/Orals/204.htm
an interesting detail is they seemed to dose supplements to reach serum gt 32 ng/ml whereas gt 15 ng/mL(or equivalently gt 37.5 nmol/L) is the usual 'normal' range (see
http://ods.od.nih.gov/factsheets/vitamind.asp
so they dosed to reach over twice normal level - am I reading that right?
http://www.kenes.com/easl2010/Orals/204.htm
an interesting detail is they seemed to dose supplements to reach serum gt 32 ng/ml whereas gt 15 ng/mL(or equivalently gt 37.5 nmol/L) is the usual 'normal' range (see
http://ods.od.nih.gov/factsheets/vitamind.asp
so they dosed to reach over twice normal level - am I reading that right?
I found this on the HCV Advocate website under Journal Review. I guess they go through the medical journals every month and find the hepatitis related article. This is the whole article. I imagine you could go to the EASL webiste or google the doctors and find a little more info.
Thanks for posting this.
I've read that vitamin D can help with glucose levels and healthy bones.
The best source of vitamin D is sunshine and, its free!
The sun can damage but it is essential to our health. I think the key is moderation. I wear a sunhat but try to get daily sunshine on my arms and legs, weather permitting.
Like you, when or if I tx again, I'll add a vitamin D supplement.
I've read that vitamin D can help with glucose levels and healthy bones.
The best source of vitamin D is sunshine and, its free!
The sun can damage but it is essential to our health. I think the key is moderation. I wear a sunhat but try to get daily sunshine on my arms and legs, weather permitting.
Like you, when or if I tx again, I'll add a vitamin D supplement.
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