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Low vitamin D levels are associated with impaired virologic response to PEGIFN + RBV therapy in HIV–hepatitis C virus coinfected patients

2012; Lippincott Williams & Wilkins; Volume: 27; Issue: 2 Linguagem: Inglês

10.1097/qad.0b013e32835aa161

1473-5571

Mattias Mandorfer, Thomas Reiberger, B.A. Payer, Arnulf Ferlitsch, F Breitenecker, Maximilian C. Aichelburg, Barbara Obermayer‐Pietsch, Armin Rieger, Michael Trauner, Markus Peck‐Radosavljevic,

HIV/AIDS drug development and treatment

Background: Low 25-hydroxyvitamin D [25(OH)D] levels are commonly found in HIV–hepatitis C virus (HCV) coinfected patients and are associated with liver fibrosis. No association between 25(OH)D levels and response to pegylated interferon α-2a/2b plus ribavirin (PEGIFN + RBV) has yet been reported for HIV–HCV coinfected patients. Design: Epidemiological characteristics, HIV and HCV infection parameters, liver biopsies, as well as data on virologic response was available in 65 patients who received chronic hepatitis C (CHC) therapy with PEGIFN + RBV within a prospective trial. 25(OH)D levels were retrospectively assessed using stored screening serum samples obtained within 35 days prior to CHC treatment. Methods: According to their 25(OH)D levels, patients were assigned to the normal (>30 ng/ml; D-NORM), the insufficiency (10–30 ng/ml; D-INSUFF), or the deficiency ( 6 × 105 IU/ml), advanced liver fibrosis (METAVIR F3/F4), and IL28B rs12979860non-C/C were considered as established risk factors for treatment failure in HIV–HCV coinfected patients. Results: Thirty-seven (57%) and 15 (23%) patients presented with D-INSUFF and D-DEF, respectively, whereas only 13 (20%) patients had normal 25(OH)D levels. Substantial differences in cEVR (D-NORM 92% vs. D-INSUFF 68% vs. D-DEF 47%; P = 0.008) and SVR (D-NORM 85% vs. D-INSUFF 60% vs. D-DEF 40%; P = 0.029) rates were observed between 25(OH)D subgroups. Especially in difficult-to-treat patients with multiple (three to four) established risk factors, low 25(OH)D levels were clearly associated with lower rates of SVR [patients without 25(OH)D deficiency 52% vs. D-DEF 0%; P = 0.012]. Conclusion: Low 25(OH)D levels may impair virologic response to PEGIFN + RBV therapy, especially in difficult-to-treat patients. Vitamin D supplementation should be considered and evaluated prospectively in HIV–HCV coinfected patients receiving CHC treatment.