Welcome to the new academic journal OBM Hepatology and Gastroenterology. Recent progress in understanding liver, biliary, pancreatic and gastro-intestinal diseases and their treatments has been observed in the world. OBM Hepatology and Gastroenterology publishes interesting and informative reviews, original articles, and invaluable case reports in this area. We also publish basic research as well as clinical research.

Hepatitis A virus (HAV), HBV, HCV, HDV, and HEV are still a serious issue worldwide. Treatments on these viruses have recently improved. However, liver fibrosis, cirrhosis and hepatocellular carcinoma are still critical conditions. We focus on all of these liver diseases. We also focus on broad-spectrum of gastro-intestinal diseases in this journal.

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Open Access Opinion
Vitamin D in Patients with Chronic Hepatitis C Virus Infection Receiving the Direct Antiviral Agents

Hsuan-Wei Chen , Hsuan-Hwai Lin , Yu-Lueng Shih , Tsai-Yuan Hsieh , Jung-Chun Lin *

Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Correspondence: Jung-Chun Lin

Academic Editor: Chung-Feng Huang

Special Issue: Unmet Need in the Management of Chronic Hepatitis C

Received: February 23, 2020 | Accepted: March 23, 2020 | Published: March 30, 2020

OBM Hepatology and Gastroenterology 2020, Volume 4, Issue 1, doi:10.21926/obm.hg.2001044

Recommended citation: Chen HW, Lin HH, Shih YL, Hsieh TY, Lin JC. Vitamin D in Patients with Chronic Hepatitis C Virus Infection Receiving the Direct Antiviral Agents. OBM Hepatology and Gastroenterology 2020;4(1):4; doi:10.21926/obm.hg.2001044.

© 2020 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Keywords

Vitamin D; chronic hepatitis C; liver disease

Recent studies have investigated the relationship between the vitamin D status of patients with chronic hepatitis C (CHC) [1]. Some researchers found no insufficient vitamin D in noncirrhotic viral liver disease [2]. However, the majority insisted that the hepatitis C virus (HCV)-positive subjects have deficient vitamin D levels [3,4,5]. Similarly, in our CHC cohort [6], up to 38% of the HCV infected patients had vitamin D deficiency (< 20 ng/mL).

Some in vitro studies have uncovered the synergic effect of vitamin D and interferon-based treatment in inhibiting HCV RNA replication [7,8,9]. Consistent with these findings, some researchers reported a positive correlation between 25-hydroxyvitamin D3 levels and the success rate of achieving the sustained virological response (SVR) [10,11,12], but others failed to establish any consistency in results [13,14,15,16]. However, in the era of direct antiviral agents (DAA), pre-treatment vitamin D level does not impact treatment response [17,18].

It has been known that 1,25(OH)2D3 treatment could be able to slow the fibrotic progression of hepatic stellate cells, via the transduction of vitamin D—vitamin-D-receptor signaling. This signaling pathway inhibits the expression of pro-fibrogenic genes and reduces liver fibrosis induced by thioacetamide in vitro and in vivo, respectively [18]. These findings suggest a role of vitamin D deficiency in liver fibrosis. However, patients’ clinical data remain scarce and inconclusive.

Another issue is concerning the kinetic changes in vitamin D after achieving SVR, but even in this case, the data are inadequate. Only Lange et al. investigated serum vitamin D status before and after antiviral therapy in 50 HCV patients with SVR. They discovered a trend toward a lower incidence of severe vitamin D deficiency after HCV eradication. An improved hepatic function resulted from the eradication of HCV may also positively contribute to the production of vitamin D. However, it should also be clarified that whether hypovitaminosis D regresses or worsens after SVR.

In summary, despite vitamin D deficiency is common in CHC, vitamin D level has no synergic effect with DAA therapy in HCV-infected patients. However, among patients who achieved an SVR for HCV, some patients (48%) did not regress after SVR, and some (6%) even worsened, with an increased risk for hepatocellular carcinoma [19]. Therefore, further clinical studies are required to evaluate the role of vitamin D in hepatic fibrogenesis and possible therapeutic use of supplementation of vitamin D in patients after the SVR.

Acknowledgments

We thank the patients who participated in this study. This study was supported in part by the grants from the Foundation for Medical Research of Tri-Service General Hospital (TSGH-C99-167 & TSGH-C-108-074).

Author Contributions

HW.C. and JC.L. drafted the article. HW.C., HH.L., YL.S., TY.H., and JC.L. recruited the patients, analyzed and interpreted the data. TY.H. gave a critical advice. JC.L. edited the article and approved the final version to be published. All authors read and approved the final manuscript.

Competing Interests

There is no conflict of interest to disclose.

References

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  2. Duarte MP, Farias ML, Coelho HS, Mendonça LM, Stabnov LM, do Carmo d Oliveira M, et al. Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. J Gastroenterol Hepatol. 2001; 16: 1022-1027. [CrossRef]
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