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Vitamin D Has Benefits in Chronic HCV Infection
Vitamin D Has Benefits in Chronic HCV Infection
November 5, 2009 (Boston, Massachusetts) — Supplementing pegylated interferon-alfa2b and ribavirin with a daily dose of vitamin D might increase virologic response rates, according to results of a late-breaking abstract reported here at The Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).
"Vitamin D is a potent immunomodulator whose impact on virologic response rates of interferon-based treatment of chronic HCV [hepatitis C] is unknown," lead investigator Saif M. Abu-Mouch, MD, from the Department of Hepatology, Hillel Yaffe Medical Center, in Hadera, Israel, and colleagues note in their abstract.
"This preliminary study confirms the benefit of adding vitamin D to conventional antiviral therapy in patients with chronic HCV," Dr. Abu-Mouch told meeting attendees.
In the study, 58 patients with confirmed chronic HCV (genotype 1) were randomly assigned to peginterferon-alfa2b (1.5 µg/kg once weekly) plus ribavirin (1000 to 2000 mg/day). Thirty-one patients also received vitamin D (1000 to 4000 IU/day; serum level >32 ng/mL).
The vitamin D group had a higher mean body mass index (27 vs 24 kg/m2; P < .01), viral load (68% vs 58%; P F2, 55% vs 18%; P < .001) than the group that did not receive vitamin D. Demographics, disease characteristics, ethnicity, baseline biochemical parameters, and adherence to treatment were similar in the 2 study groups.
A rapid virologic response was seen at week 4 in 44% of the vitamin D group and in 18% of the control group. At week 12, Dr. Abu-Mouch told Medscape Gastroenterology, 96% of the vitamin D group (26 of 27 patients) were HCV RNA-negative, as assessed by reverse-transcriptase polymerase chain reaction, as was 48% of the control group (15 of 31 patients), which was a significant difference (P < .001), he said.
The combination of peginterferon and ribavirin, the standard of care for chronic HCV, achieves a sustained virologic response in 40% to 50% of naïve patients with genotype 1, the investigators explain in a meeting abstract. Vitamin D in combination with peginterferon-ribavirin "may have synergistic effects," Dr. Abu-Mouch said.
Meeting attendee Laurent Tsakiris, MD, from the Centre Hospitalier Universitaire de Melun in France, who was not involved in the study, told Medscape Gastroenterology that "the study is surprising and promising because vitamin D is something very easy to use and there is no toxicity."
"It's also interesting," he said, "that the group treated with vitamin D had more severe disease than the control group. I think this can be considered a strong result from a small study.
The study did not receive commercial support. Dr. Abu-Mouch and Dr. Tsakiris have disclosed no relevant financial relationships.
The Liver Meeting 2009: 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): Abstract LB20. Presented November 2, 2009.
See: http://www.medscape.com/viewarticle/711902?sssdmh=dm1.553076&src=nldne&uac=39980BG
Mike
November 5, 2009 (Boston, Massachusetts) — Supplementing pegylated interferon-alfa2b and ribavirin with a daily dose of vitamin D might increase virologic response rates, according to results of a late-breaking abstract reported here at The Liver Meeting 2009, the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).
"Vitamin D is a potent immunomodulator whose impact on virologic response rates of interferon-based treatment of chronic HCV [hepatitis C] is unknown," lead investigator Saif M. Abu-Mouch, MD, from the Department of Hepatology, Hillel Yaffe Medical Center, in Hadera, Israel, and colleagues note in their abstract.
"This preliminary study confirms the benefit of adding vitamin D to conventional antiviral therapy in patients with chronic HCV," Dr. Abu-Mouch told meeting attendees.
In the study, 58 patients with confirmed chronic HCV (genotype 1) were randomly assigned to peginterferon-alfa2b (1.5 µg/kg once weekly) plus ribavirin (1000 to 2000 mg/day). Thirty-one patients also received vitamin D (1000 to 4000 IU/day; serum level >32 ng/mL).
The vitamin D group had a higher mean body mass index (27 vs 24 kg/m2; P < .01), viral load (68% vs 58%; P F2, 55% vs 18%; P < .001) than the group that did not receive vitamin D. Demographics, disease characteristics, ethnicity, baseline biochemical parameters, and adherence to treatment were similar in the 2 study groups.
A rapid virologic response was seen at week 4 in 44% of the vitamin D group and in 18% of the control group. At week 12, Dr. Abu-Mouch told Medscape Gastroenterology, 96% of the vitamin D group (26 of 27 patients) were HCV RNA-negative, as assessed by reverse-transcriptase polymerase chain reaction, as was 48% of the control group (15 of 31 patients), which was a significant difference (P < .001), he said.
The combination of peginterferon and ribavirin, the standard of care for chronic HCV, achieves a sustained virologic response in 40% to 50% of naïve patients with genotype 1, the investigators explain in a meeting abstract. Vitamin D in combination with peginterferon-ribavirin "may have synergistic effects," Dr. Abu-Mouch said.
Meeting attendee Laurent Tsakiris, MD, from the Centre Hospitalier Universitaire de Melun in France, who was not involved in the study, told Medscape Gastroenterology that "the study is surprising and promising because vitamin D is something very easy to use and there is no toxicity."
"It's also interesting," he said, "that the group treated with vitamin D had more severe disease than the control group. I think this can be considered a strong result from a small study.
The study did not receive commercial support. Dr. Abu-Mouch and Dr. Tsakiris have disclosed no relevant financial relationships.
The Liver Meeting 2009: 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD): Abstract LB20. Presented November 2, 2009.
See: http://www.medscape.com/viewarticle/711902?sssdmh=dm1.553076&src=nldne&uac=39980BG
Mike
Very interesting and something (Vit. D) that I am researching lately. Thanks for posting these studies, Mike. I had a lot of bone loss after TX and am trying track down the cause. Could be a multitude of reasons: poor absorption of calcium caused by PI or riba, low conversion of Vit. D caused by liver damage, dramatically decreased female hormone levels caused by interferon. Gynecologist insisted on calcium + vitamin D supplementation even though my calcium levels were high (but in normal range) throughout TX. Recent tests showed Vit. D at 32 (normal range 30-80). At 6 mo. check-up, I had moved to higher than normal levels of calcium because of supplements and they still wanted me to take the calcium. Screeew that. I sure don't want to keep overdosing on calcium until I get kidney stones or worse. I stopped the calcium and switched to 400-800 units vitamin D after researching that it would be almost impossible to overdose on D and knowing that I have fairly low, though normal, levels of D so have some leeway in adding extra through supplementation. Finally got a decent night's sleep from not getting up for the bathroom all night for my body to rid itself of excess calcium. Nice to think that I might get smarter taking it, too : ).
newleaf
you done exactly the right thing!! vit d without calcium is what is needed
adding vit d to diet particuarly during tx is nothing new, iam currently pre dosing for forthcoming tx
most heppers are difiecient in vit d , not all of course before someone starts saying "well johnny down the road has'nt"
it seems that it is becoming normal in the states to have a vit d check, as your doctor for that in the uk and he will laugh because by in large british Gp are clueless when it comes to hep c, infact so are the hep c doctors but thats another matter
you done exactly the right thing!! vit d without calcium is what is needed
adding vit d to diet particuarly during tx is nothing new, iam currently pre dosing for forthcoming tx
most heppers are difiecient in vit d , not all of course before someone starts saying "well johnny down the road has'nt"
it seems that it is becoming normal in the states to have a vit d check, as your doctor for that in the uk and he will laugh because by in large british Gp are clueless when it comes to hep c, infact so are the hep c doctors but thats another matter
From Medscape at http://www.medscape.com/viewarticle/516238_4
".....Evaluation and Treatment of Vitamin D Deficiency
Measurement of 25(OH)D is the only means to determine whether a patient is vitamin D deficient or sufficient. The measurement of 1,25(OH)2D is not only useless, but can mislead the physician because it is often either normal or even elevated when a patient is vitamin D deficient and has secondary hyperparathyroidism. Most commercial laboratories report that a 25(OH)D less than 10 ng/mL is synonymous with vitamin D deficiency. Most experts recommend that less than 20 ng/mL should be designated as vitamin D deficiency.[28-30] To maintain a healthy level of 25(OH)D, the recommendation is that it should be above 30 ng/mL.
The easiest way to correct vitamin D deficiency is to fill up the empty vitamin D tank by giving the patient an oral dose of 50,000 IU of vitamin D once per week for 8 weeks. To maintain vitamin D sufficiency, the patient should receive either 50,000 IU of vitamin D once or twice per month thereafter. There is an intramuscular form of vitamin D that is usually not very bioavailable and can cause significant discomfort; therefore it is not recommended. However, in Europe, intramuscular injection of 500,000 IU of vitamin D twice per year has appeared to be effective in preventing vitamin D deficiency.
A multivitamin containing 400 IU of vitamin D is inadequate to satisfy the body's requirement.[32] It is estimated that at least 1,000 IU of vitamin D per day is needed to satisfy the body's requirement....."
".....Evaluation and Treatment of Vitamin D Deficiency
Measurement of 25(OH)D is the only means to determine whether a patient is vitamin D deficient or sufficient. The measurement of 1,25(OH)2D is not only useless, but can mislead the physician because it is often either normal or even elevated when a patient is vitamin D deficient and has secondary hyperparathyroidism. Most commercial laboratories report that a 25(OH)D less than 10 ng/mL is synonymous with vitamin D deficiency. Most experts recommend that less than 20 ng/mL should be designated as vitamin D deficiency.[28-30] To maintain a healthy level of 25(OH)D, the recommendation is that it should be above 30 ng/mL.
The easiest way to correct vitamin D deficiency is to fill up the empty vitamin D tank by giving the patient an oral dose of 50,000 IU of vitamin D once per week for 8 weeks. To maintain vitamin D sufficiency, the patient should receive either 50,000 IU of vitamin D once or twice per month thereafter. There is an intramuscular form of vitamin D that is usually not very bioavailable and can cause significant discomfort; therefore it is not recommended. However, in Europe, intramuscular injection of 500,000 IU of vitamin D twice per year has appeared to be effective in preventing vitamin D deficiency.
A multivitamin containing 400 IU of vitamin D is inadequate to satisfy the body's requirement.[32] It is estimated that at least 1,000 IU of vitamin D per day is needed to satisfy the body's requirement....."
1,000 huh my Centrum does only have 400. I think I will have to make a trip to the health store this week.....especially for women that is a huge difference and I know mine is like newleafs on the low end of normal....wouldn't take much to go under easily enough.
Good info.
Good info.
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