ABSTRACT
According to the Institute of Medicine, the risk of clinically significant vitamin
D deficiency increases at 25-hydroxyvitamin D levels below 20 ng/mL. By this standard,
most cirrhotic hepatitis C virus- (HCV-) positive patients and many noncirrhotic patients
are vitamin D-deficient. The high prevalence of vitamin D deficiency among HCV patients
is a cause for concern for several specific reasons. Classic studies established the
importance of vitamin D and calcium in maintaining bone. Vitamin D's beneficial effects
on bone are likely to be vital for HCV-infected patients because these individuals
have a high prevalence of low bone mineral density. Many pharmaceutical agents reduce
bone density and exposure to these drugs may increase bone disease in HCV-positive
patients. Bone loss occurs following liver transplantation and bone density is often
low in patients with HIV/HCV co-infection who are on combination antiretroviral therapy.
Some evidence suggests that ribavirin reduces bone density, underscoring the special
need to monitor vitamin D in patients receiving HCV treatment and to prescribe supplements,
as appropriate. In addition to its role in calcium metabolism, vitamin D is also an
immune modulator that reduces inflammation while enhancing protective immune responses.
Higher vitamin D levels are associated with less liver fibrosis and less inflammation
in HCV patients. Recent studies show that low vitamin D levels are associated with
treatment failure among HCV-infected patients receiving pegylated-interferon and ribavirin.
If confirmed, these findings will provide an additional reason to ensure adequate
levels of vitamin D. Information about how to monitor vitamin D status and how to
use vitamin D supplements most effectively in HCV-infected patients is provided.
KEYWORDS
Hepatitis C virus - vitamin D - hepatocellular carcinoma - bone mineral density -
fracture - fibrosis - sustained virologic response - interferon - ribavirin
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Andrea D. BranchPh.D.
Division of Liver Diseases, The Mount Sinai School of Medicine
Box 1104, One Gustave L. Levy Place, New York, NY 10029
eMail: andrea.branch@mssm.edu
