SERUM LEVEL OF 25-(OH) VITAMIN D DOES NOT AFFECT THE EFFICACY OF INTERFERRON-FREE TREATMENT REGIMES FOR PATIENTS WITH HCV INFECTION
DOI:
https://doi.org/10.11603/1681-2727.2020.3.11550Keywords:
HCV infection, vitamin D, fibrosis, treatment effectivenessAbstract
The prevalence of HCV infection varies in different countries and is one of the highest in Ukraine. Vitamin D is a fat-soluble secosteroid with various systemic effects. In addition to controlling calcium homeostasis, vitamin D has a significant effect on innate and acquired immune responses, as well as it inhibits HCV replication. The aim of the study was to investigate the effect of 25- (OH) vitamin D concentration in serum on the effectiveness of treatment of the patients with HCV infection using direct antiviral drugs.
Materials and methods. The study included 73 adult patients with HCV infection. There were 38 men (52.1 %) and 35 women (47.9 %). Genotype 1b HCV was identified in 55 (75.3 %) individuals, and genotype 3a HCV was identified in 18 (24.7 %). According to the METAVIR scale, the minimal fibrosis (F0-1) was determined in 7 (9.6 %) patients, the significant fibrosis (F2) – in 17 (23.3 %), severe fibrosis (F3) – in 21 (28.7 %) and cirrhosis of the liver (F4) – in 28 (38.4 %) patients. Depending on the HCV genotype and the stage of liver fibrosis in treatment, 43 (58.9 %) patients received a combination of ombitasvir/paritoprevir/ritonavir and dasabuvir for 12 weeks, and in 30 (41.1 %) – a combination of sofosbuvir and ribavirin for 12 or 24 weeks.
Results. Among the 73 patients who were included in the study, the median concentration of 25- (OH) D was 27.07 ng/ml (12.1 to 45.9 ng / ml). Normal level of 25-(OH) vitamin D was recorded in 30 (41.1 %) people, insufficiency was found in 28 (38.4 %) patients, and deficiency was found in 15 (20.5 %) people. The indicator of SVR12 (sustained virological response) did not depend (P>0.05) on the serum concentration of 25-(OH) vitamin D and in patients with normal vitamin D level it was 100 % (95 % CI: 88.4–100 %), with insufficiency – 96.4 % (95 % CI: 81.7–99.9 %), and with deficiency – 93.3 % (95 % CI: 68.1–99.8 %). Also, the rate of SVR12 did not depend (P>0.05) on the age of patients, HCV genotype, HCV viral load, previous treatment, the presence of liver cirrhosis and treatment regimen. The average level of 25-(OH) vitamin D in patients with minimal fibrosis (F1) was 37.8 (35.8-43.5) ng/ml. In patients with cirrhosis of the liver (F4) the concentration of 25-(OH) vitamin D was 19.3 (18.1-25.84) ng/ml and it was 1.96-1.67 times lower (P<0.05) compared to patients with minimal or significant fibrosis (F1-F2) and 1.38 times lower (P<0.05) than in severe fibrosis (F3). The average level of 25-(OH) vitamin D in patients with F2-F3 fibrosis stage was significantly lower (P<0.05) than in patients with portal fibrosis (F1) – 32.3 (29.8–35.5) ng/ml and 26.8 (25.55-37.1) ng/ml compared to 37.8 (35.8–43.5) ng/ml, respectively.
Conclusions. Serum level of 25-(OH) vitamin D does not affect the effectiveness of treatment of patients with HCV infection using direct antiviral drugs. In patients with HCV infection and cirrhosis of the liver, the concentration of 25-(OH) vitamin D is 1.96–1.67 times lower (P<0.05) compared to the patients with minimal or significant liver fibrosis (F1-F2) and 1.38 times lower (P<0.05) than in patients with severe fibrosis (F3).
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