Effect Of Vitamin D Status and Serum Ferritin Concentration On Early Virological Response Of Chronic Hepatitis C Virus To Standard Care Therapy

Abstract

The main aim of this study is evaluation of pretreatment serum ferritin and vitamin D levels as predictors for early and rapid virological response in chronic hepatitis C (CHC) patients receiving combined pegylated Interferon and Ribavirin therapy. This study was conducted on 30 naïve patients with CHC virus infection genotype 4. All patients were subjected to full history taking. Thorough clinical examination. Continuous monitoring of liver profile (to detect elevation of liver enzymes). Continuous monitoring of ferritin and vitamin D levels. Monitoring of viral response at 4 and 12 weeks of the treatment by the Polymerase Chain Reaction (PCR) of the viral RNA. The study included 30 patients divided A. According to RVR: All patients achieved rapid virological response. B. According to EVR: · Thirty three patients who achieved early virological response. · Sixty six patients who didn’t achieve early virological response. 152 In our study, we found that the level of pretreatment serum ferritin was lower in patients who achieved early virological response than those who didn’t. In contrast, we found that the highest value for serum ferritin during the first 12 weeks of the antiviral therapy was higher in the EVR group when compared to non EVR with significant statistical difference. Also the level of pretreatment vitamin D was higher in patients who achieved rapid and early virological response than those who didn’t. It is speculated that serum ferritin and vitamin D levels during therapy are indirect markers for interferon effect, the greater the serum ferritin and vitamin D levels, the greater the interferon effect. And indeed in our study it was demonstrated that patients who had early virological response had higher on treatment serum ferritin and vitamin D levels during the first 12 weeks of treatment. As regard the viral load, we have found that lower pretreatment viral load is an indicator of better rates of response at week 4 of treatment using combined therapy. 153 Conclusion and Recommendations 1. The pretreatment serum ferritin was lower in patients with early virological response. 2. The pretreatment (25-OH)vitamin D was higher in patients with early virological response. 3. The early virological response was achived in patients who have an increase in serum ferritin than those who didn’t during treatment with pegylated interferon together with ribavirin. 4. The cut off value of pretreatment serum ferritin was ≤219 ng/ml in predicting EVR with positive predictive value 52.9% and sensitivity 90%. 5. The cut off value of pretreatment (25-OH) vitamin D was≥ 15ng/ml in predicting EVR with positive predictive value 75% and sensitivity 90%. 6. Study of (25-OH) vitamin D supplementation on EVR in patients with chronic hepatitis C receiving combination therapy (pegylated interferon and ribavirin). 7. Further study to be done to assay serum (25-OH) vitamin D level in prediction of SVR 12 week in triple combination therapy (Sofosbuvir, pegylated interferon and ribavirin). Therefore we recommend that serum ferritin and vitamin D levels should be included in the biochemical workup of CHC patients before and during therapy, particularly in situations where resources for an appropriate virological workup are limited, as they could be cheap markers for the response to interferon-based therapy.