Low vitamin D levels are associated with impaired virologic response to PEGIFN+RBV therapy in HIV/HCV coinfected patients

AIDS. 2012 Oct 1. [Epub ahead of print]

Mandorfer M, Reiberger T, Payer BA, Ferlitsch A, Breitenecker F, Aichelburg MC, Obermayer-Pietsch B, Rieger A, Trauner M, Peck-Radosavljevic M; Vienna HIV & Liver Study Group.

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aDivision of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna bDivision of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna cDivision of Endocrinology and Metabolism, Department of Internal Medicine, Medical University Graz.

Abstract

BACKGROUND:: Low 25-hydroxyvitamin D (25(OH)D) levels are commonly found in HIV/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 (<10 ng/ml; D-DEF) group. HCV-GT 1/4, high HCV-RNA load (>6 × 10IU/ml), advanced liver fibrosis (METAVIR F3/F4), and IL28B rs12979860 non-C/C SNP were considered as established risk factors for treatment failure in HIV/HCV coinfected patients. RESULTS:: 37 (57%) and 15 (23%) patients presented with D-INSUFF and D-DEF, respectively, while 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 (3-4) 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). CONCLUSIONS:: 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.

PMID: 23032421 [PubMed - as supplied by publisher]

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