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Viral hepatitis
P75 Influence of vitamin D supplementation on outcome in the treatment of chronic hepatitis C
  1. P Southern,
  2. P El-Sayed,
  3. L Fenton,
  4. K Forrester,
  5. S Morrea
  1. Digestive Diseases Centre, Bradford Teaching Hospitals, UK

Abstract

Introduction Vitamin D, acting as an immune modulator, has recently been shown to increase the sustained virological response (SVR) in genotype 1 patients.

Aim To retrospectively examine the outcome of patients treated in our institution using pegylated interferon and ribavirin, and compare the effects of treatment with a Vitamin D preparation.

Method All patients in our treatment database who have received treatment for Hepatitis C using Pegylated Interferon were identified. Only those patients who were greater than 6 months post treatment were included. Data collected included genotype, fibrosis score (Ishak) and if they were prescribed Vitamin D preparations, The primary outcome was to attain a SVR, defined as persistently negative HCV PCR status 6 months after cessation of anti viral therapy.

Results Data were available for 206 patients treated over a 3 year period. Total SVR by genotype was as follows, Genotype 1–39 % (n=44), Genotype 2–71 % (n=8), Genotype 3–72% (n=151) and Genotype 4–100% (n=3).

27.5 % (n=57) of our patients received Vitamin D supplementation with Calcichew D3 Forte (Shire Pharmaceuticals, Hampshire, UK) during the course of treatment, an observed SVR rate of 72 % was seen in those receiving supplementation compared to 64 % in those not supplemented (p=0.281).

When examining patients by genotype, no patients with genotype 1 received Vitamin D therapy. Of Genotype two patients 25 % (n=2) were treated with Vitamin D, achieving a 50 % SVR compared to 83.3% for those not treated with Vitamin D. 34 % of Genotype 3 patients received Vitamin D (n=52) achieving an SVR in 77% of cases, compared to those who did not receive supplementation (n=99) with an SVR of 71% (p=0.414).

From the subset of genotype three patients, the SVR for fibrosis scores <4 and 5/6 were 78% and 53 % respectively. When these groups were analysed considering Vitamin D supplementation those with fibrosis scores of <4 receiving supplementation achieved an SVR of 87% compared to 74% in those not (p=0.183). Patients with fibrosis scores of 5/6 achieved an SVR of 53 % in both supplemented and non-supplemented groups.

Outcomes were also analysed using fibrosis scores, as expected those with less significant fibrosis achieved SVR more frequently, no significant differences were detected when the data were analysed using treatment with Vitamin D as a variable.

Conclusion Our data show that Vitamin D supplementation could improve the SVR in Genotype three patients with mild/moderate fibrosis, this has not been reported so far. We suggest routine testing of vitamin D levels prior to combination therapy and replacement during treatment for chronic hepatitis C.

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