Abstract
Background: Both the anti-infective and anti-inflammatory properties of vitamin D, an essential hormone of calcium homeostasis, have ample support in the literature. The high rates of vitamin D deficiency among patients with chronic hepatitis C are also well known. That supplementation with vitamin D may boost sustained viral response rates in vitamin D deficient, hepatitis C virus (HCV) infected patients undergoing Interferon-alpha (IFN) treatment, on the other hand, is controversial. Surprisingly, studies considering in this latter setting what are the effects of IFN treatment (with or without vitamin D supplementation) on the other major regulator of mineral metabolism, i.e. the Parathyroid hormone (PTH), are lacking. Aim: Evaluate the impact of interferon-based treatment against HCV (±cholecalciferol supplementation) on vitamin D and PTH homeostasis. Methods: A series of 40 consecutive patients received pegylated IFN plus ribavirin to treat chronic hepatitis C. At the discretion of their physician, some of them (N. = 27) received vitamin D supplementation while others did not (N. = 13). All had measured plasma 25-hydroxycholecalciferol and PTH concentrations at baseline, at completion of the 4th (TW4) and 12th treatment week (TW12) and at 24 weeks after the end of therapy (SVR24). Results: Plasma PTH concentration increased significantly from baseline during treatment, raising to 44.8 [30.7-57.2] pg/mL at TW4 (p=0.01), 47.0 [37.1-63.2] pg/mL at TW12 (p=0.006) to return to baseline levels in the follow-up (34.5 [27.6-43.0]; p=0.16). The proportion of patients who satisfied criteria for hyperparathyroidism was higher at TW12 (N=10, 25%) than at TW4 (N=6, 15%). There was no statistical correlation between vitamin D and PTH blood levels (ρ=-0.07; p=0.65). Conclusion: An increase in plasma PTH occurs systematically during IFN treatment of HCV patients and cannot be prevented by vitamin D supplementation.
Highlights
Chronic hepatitis C is one of the most widespread liver diseases in the world, with over 170 million individuals infected with the hepatitis C virus (HCV) and 3-4 million new cases every year [1, 2]
Before the introduction of the Direct-Acting Antivirals (DAAs) [3], the standard of care consisted of the combination of Pegylated (PEG) Interferonalfa (IFN) and ribavirin administered for a period of 24 or 48 weeks, depending on HCV genotype [4]
We aimed to evaluate the effect of chronic hepatitis C on vitamin D/Parathyroid hormone (PTH) axis and whether IFN-based regimens have a predictable an impact on vitamin D homeostasis
Summary
Chronic hepatitis C is one of the most widespread liver diseases in the world, with over 170 million individuals infected with the hepatitis C virus (HCV) and 3-4 million new cases every year [1, 2]. The high efficacy and excellent safety profile of DAAs have made IFN treatment of HCV infection obsolete in many parts of the world, though the pathophysiology of hepatitis C remains linked to activation of the interferon system [12] and other indications for the use of IFN remains, despite its toxicity. For these reasons, dissecting the intricacies of the relationship between IFN and vitamin D is not futile. Studies considering in this latter setting what are the effects of IFN treatment (with or without vitamin D supplementation) on the other major regulator of mineral metabolism, i.e. the Parathyroid hormone (PTH), are lacking
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