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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
I take 1000 IU daily.
Mike
Mike
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.
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....."
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
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 : ).
From Medscape Medical News
Vitamin D May Influence Cognitive Dysfunction and Dementia
Allison Gandey
December 3, 2009 — Vitamin D has been receiving a lot of attention recently, and now researchers report that inadequate vitamin D levels may be involved in cognitive dysfunction and dementia.
Two papers show in separate populations that low levels of vitamin D are associated with cognitive impairment and cerebrovascular disease, including stroke. A third study of only men finds no such association. The papers will appear in the January issue of Neurology.
"What should we make of these studies?" Joshua Miller, PhD, from the University of California in Sacramento, asked in an accompanying editorial. "First, it is evident that the prevalence of vitamin D deficiency is very high among older adults."
Vitamin D deficiency is very high among older adults.
This in and of itself, he says, could warrant expanded screening for vitamin D deficiency and adding supplements. "Whether vitamin D supplements will maintain cognitive function in older adults remains an open question," he notes.
Dr. Miller does not rule out the possibility of reverse causation. "Cognitively impaired older adults may eat poorly or they may have reduced exposure to sunlight, which could lead to reduced vitamin D status."
Investigators led by Cédric Annweiler, MD, from Angers University Hospital in France, conducted a cross-sectional study exploring these questions. Their paper was released early online September 30. The researchers looked at more than 750 community-dwelling older women. Participants were from the French study known as Epidémiologie de l'Ostéoporose. The women were 75 years or older.
The researchers report that 17% of participants had vitamin D deficiency. This was defined as a serum 25-hydroxyvitamin D level of less than 10 ng/mL. Women with vitamin D deficiency had lower mean Short Portable Mental State Questionnaire scores (P < .001). They also had an odds ratio for cognitive impairment of about 2 after controlling for relevant confounders.
The authors conclude that inadequate vitamin D is associated with cognitive impairment in elderly women and that vitamin D supplements may improve or maintain cognitive function.
Two Studies, Similar Conclusion
The second report, by investigators led by Jennifer Buell, PhD, from Tufts University in Boston, Massachusetts, and released November 25, came to a similar conclusion. The researchers also conducted a cross-sectional study — this one of more than 300 men and women.
Participants were 65 years or older and were involved in the Nutrition and Memory in Elders study. They were evaluated for dementia and cerebrovascular disease and underwent magnetic resonance imaging to assess overall and regional brain volumes, white matter hyperintensity, and infarcts.
Investigators show that 14% of the study sample had inadequate vitamin D. Another 44% were classified as vitamin D insufficient (10 to 20 ng/mL).
Patients with low vitamin D levels had higher white matter hyperintensity volume and a higher prevalence of large vessel infarcts. Low vitamin D level was also linked with an odds ratio of about 2 for all-cause dementia, Alzheimer's disease, and stroke after controlling for relevant confounders.
The authors conclude that vitamin D deficiency is associated with an increased risk for dementia and cerebrovascular disease and that vitamin D may have vasculoprotective properties.
However, a third report, also released November 25, came to a different conclusion.
Third Study Questions Evidence
Investigators led by Yelena Slinin, MD, from the VA Medical Center and the University of Minnesota at Minneapolis, found little evidence linking vitamin D and cognitive impairment.
The researchers conducted a longitudinal assessment of more than 1600 community-dwelling men. Participants were 65 years or older and were involved in the Osteoporotic Fractures in Men Study.
Investigators assessed cognitive function using the modified Mini-Mental State Examination and the Trails B test.
At baseline, the odds ratios for cognitive impairment were between 1.6 and 1.8 in the lowest vitamin D quartile compared with the highest. However, these odds ratios did not reach statistical significance and were lower after controlling for race, ethnicity, and education.
Low vitamin D level was defined differently in this study at less than 20 ng/mL. In the other 2 studies, vitamin D deficiency was considered less than 10 ng/mL.
For incident cognitive impairment, the odds ratio for a significant decline in Mini-Mental State Examination score was 1.5 in the lowest quartile of vitamin D concentration compared with the highest quartile. The trend across the quartiles was significant. Yet again, control for confounding by race, ethnicity, and education slightly lowered the trend — enough to lose statistical significance.
The authors suggest that additional studies should be performed that include women and tests of other cognitive domains.
Editorialist Dr. Miller argues that this study is limited by a lack of women included in the work. He says it was also limited because the lowest quartile of vitamin D status consisted of all subjects with levels under 20 ng/mL. "Perhaps a reevaluation of the data comparing deficient subjects (<10 ng/ mL) to nondeficient subjects would reveal significant associations," he notes.
Next Steps
"What are needed now are placebo-controlled intervention studies to determine if vitamin D supplements will protect against age-related cognitive decline." In the meantime, Dr. Miller says, neurologists, general practitioners, and geriatricians should be aware of the high prevalence of vitamin D deficiency in their patient populations and the possibility that supplementation could be beneficial.
Adequate vitamin D for patients aged 51 to 70 years are defined as 10 µg/day (400 IU). For people older than 70 years, 15 µg/day (600 IU) is suggested or enough to maintain a vitamin D level of about 30 ng/mL or more. These recommendations, he notes, are primarily for maintaining bone health and are evolving.
Dr. Miller suggests, "The appropriate intake amounts to support brain function in older adults remain to be determined."
Dr. Joshua Miller receives research support from the National Institutes of Health, the US Department of Defense, and the American Cancer Society. Dr. Slinin is a full-time employee of the US Department of Veterans Affairs. The other investigators have disclosed no relevant financial relationships.
Neurology. Published online September 30 and November 25, 2009
Vitamin D May Influence Cognitive Dysfunction and Dementia
Allison Gandey
December 3, 2009 — Vitamin D has been receiving a lot of attention recently, and now researchers report that inadequate vitamin D levels may be involved in cognitive dysfunction and dementia.
Two papers show in separate populations that low levels of vitamin D are associated with cognitive impairment and cerebrovascular disease, including stroke. A third study of only men finds no such association. The papers will appear in the January issue of Neurology.
"What should we make of these studies?" Joshua Miller, PhD, from the University of California in Sacramento, asked in an accompanying editorial. "First, it is evident that the prevalence of vitamin D deficiency is very high among older adults."
Vitamin D deficiency is very high among older adults.
This in and of itself, he says, could warrant expanded screening for vitamin D deficiency and adding supplements. "Whether vitamin D supplements will maintain cognitive function in older adults remains an open question," he notes.
Dr. Miller does not rule out the possibility of reverse causation. "Cognitively impaired older adults may eat poorly or they may have reduced exposure to sunlight, which could lead to reduced vitamin D status."
Investigators led by Cédric Annweiler, MD, from Angers University Hospital in France, conducted a cross-sectional study exploring these questions. Their paper was released early online September 30. The researchers looked at more than 750 community-dwelling older women. Participants were from the French study known as Epidémiologie de l'Ostéoporose. The women were 75 years or older.
The researchers report that 17% of participants had vitamin D deficiency. This was defined as a serum 25-hydroxyvitamin D level of less than 10 ng/mL. Women with vitamin D deficiency had lower mean Short Portable Mental State Questionnaire scores (P < .001). They also had an odds ratio for cognitive impairment of about 2 after controlling for relevant confounders.
The authors conclude that inadequate vitamin D is associated with cognitive impairment in elderly women and that vitamin D supplements may improve or maintain cognitive function.
Two Studies, Similar Conclusion
The second report, by investigators led by Jennifer Buell, PhD, from Tufts University in Boston, Massachusetts, and released November 25, came to a similar conclusion. The researchers also conducted a cross-sectional study — this one of more than 300 men and women.
Participants were 65 years or older and were involved in the Nutrition and Memory in Elders study. They were evaluated for dementia and cerebrovascular disease and underwent magnetic resonance imaging to assess overall and regional brain volumes, white matter hyperintensity, and infarcts.
Investigators show that 14% of the study sample had inadequate vitamin D. Another 44% were classified as vitamin D insufficient (10 to 20 ng/mL).
Patients with low vitamin D levels had higher white matter hyperintensity volume and a higher prevalence of large vessel infarcts. Low vitamin D level was also linked with an odds ratio of about 2 for all-cause dementia, Alzheimer's disease, and stroke after controlling for relevant confounders.
The authors conclude that vitamin D deficiency is associated with an increased risk for dementia and cerebrovascular disease and that vitamin D may have vasculoprotective properties.
However, a third report, also released November 25, came to a different conclusion.
Third Study Questions Evidence
Investigators led by Yelena Slinin, MD, from the VA Medical Center and the University of Minnesota at Minneapolis, found little evidence linking vitamin D and cognitive impairment.
The researchers conducted a longitudinal assessment of more than 1600 community-dwelling men. Participants were 65 years or older and were involved in the Osteoporotic Fractures in Men Study.
Investigators assessed cognitive function using the modified Mini-Mental State Examination and the Trails B test.
At baseline, the odds ratios for cognitive impairment were between 1.6 and 1.8 in the lowest vitamin D quartile compared with the highest. However, these odds ratios did not reach statistical significance and were lower after controlling for race, ethnicity, and education.
Low vitamin D level was defined differently in this study at less than 20 ng/mL. In the other 2 studies, vitamin D deficiency was considered less than 10 ng/mL.
For incident cognitive impairment, the odds ratio for a significant decline in Mini-Mental State Examination score was 1.5 in the lowest quartile of vitamin D concentration compared with the highest quartile. The trend across the quartiles was significant. Yet again, control for confounding by race, ethnicity, and education slightly lowered the trend — enough to lose statistical significance.
The authors suggest that additional studies should be performed that include women and tests of other cognitive domains.
Editorialist Dr. Miller argues that this study is limited by a lack of women included in the work. He says it was also limited because the lowest quartile of vitamin D status consisted of all subjects with levels under 20 ng/mL. "Perhaps a reevaluation of the data comparing deficient subjects (<10 ng/ mL) to nondeficient subjects would reveal significant associations," he notes.
Next Steps
"What are needed now are placebo-controlled intervention studies to determine if vitamin D supplements will protect against age-related cognitive decline." In the meantime, Dr. Miller says, neurologists, general practitioners, and geriatricians should be aware of the high prevalence of vitamin D deficiency in their patient populations and the possibility that supplementation could be beneficial.
Adequate vitamin D for patients aged 51 to 70 years are defined as 10 µg/day (400 IU). For people older than 70 years, 15 µg/day (600 IU) is suggested or enough to maintain a vitamin D level of about 30 ng/mL or more. These recommendations, he notes, are primarily for maintaining bone health and are evolving.
Dr. Miller suggests, "The appropriate intake amounts to support brain function in older adults remain to be determined."
Dr. Joshua Miller receives research support from the National Institutes of Health, the US Department of Defense, and the American Cancer Society. Dr. Slinin is a full-time employee of the US Department of Veterans Affairs. The other investigators have disclosed no relevant financial relationships.
Neurology. Published online September 30 and November 25, 2009
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