Abstract
BackgroundChronic hepatitis C (CHC) is a global health challenge. New therapeutic agents with excellent sustained virological response (SVR) rates are available mainly in developed countries, while the majority of CHC patients live in countries with low health budget. Predictors of therapeutic response are therefore necessary. Vitamin B12 appears to be involved in hepatitis C virus replication.MethodsWe therefore studied retrospectively the relationship between baseline serum vitamin B12 levels and clinical features in 116 CHC genotype 1 infected patients. Logistic regression models with univariate and multivariate analysis were used in the statistical analysis.ResultsBaseline serum vitamin B12 levels were found to be positively associated with serum transaminase activities (AST, p = 0.002, ALT, p = 0.04), baseline viral load (p < 0.0001), stage of fibrosis (p = 0.0001) and favorable interferon-λ3/4 (IFNL3/IFNL4) rs12979860 genotypes (p = 0.04), and inversely with SVR (p < 0.001) as well as with rapid virological response (p = 0.001). Patients with baseline serum vitamin B12 levels below a cut-off value of 570 ng/L achieved a SVR rate of 59% with an odds ratio (OR) of 13.4 [confidence interval (CI) 4.3–41.9, p < 0.0001] compared to patients above the cut-off value. By combining serum vitamin B12 levels and IFNL3/IFNL4 rs12979860 genotypes, patients with baseline serum vitamin B12 levels below the cut-off value of 570 ng/L and IFNL3/IFNL4 rs12979860 CC genotype achieved a SVR rate of even 80% with an OR of 54 (CI 9.9–293, p < 0.0001) compared to patients above the cut-off value and non-CC-genotypes.ConclusionOur data suggest baseline serum vitamin B12 levels as useful noninvasive marker for characterizing CHC patients. They might further help to identify responders to a standard treatment.
Highlights
Chronic hepatitis C (CHC) is a global health challenge
Patients with chronic hepatitis C virus (HCV) infection are at risk for progressive hepatic fibrosis, cirrhosis, portal hypertension, liver failure and hepatocellular carcinoma [1,2,3,4]
Besides HCV genotype, several other factors related to the virus [e.g. viral load at treatment initiation or rapid virological response (RVR)] and host have been shown to determine treatment-induced sus‐ tained virological response (SVR) in CHC patients [18,19,20,21,22,23,24]
Summary
New therapeutic agents with excellent sus‐ tained virological response (SVR) rates are available mainly in developed countries, while the majority of CHC patients live in countries with low health budget. These agents have raised the rates of SVR above 90% [9,10,11,12,13,14,15,16] These clinical trials were performed in highly selected, triaged patients and the cost of antiviral therapy i.e. is only for sofosbuvir approximately 60,000 € [17]. This is especially relevant in view of most of CHC patients living in developing countries. Besides HCV genotype, several other factors related to the virus [e.g. viral load at treatment initiation or rapid virological response (RVR)] and host (e.g. race, age, body weight, insulin resistance, serum lipids, fibrosis stage, serum ferritin concentration and genetic variations in the IFNL3/4 genes) have been shown to determine treatment-induced SVR in CHC patients [18,19,20,21,22,23,24]
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