Vitamin D in addition to peg-interferon-alpha/ribavirin in chronic hepatitis C virus infection: ANRS-HC25-VITAVIC study

AIM: To investigate if correction of hypovitaminosis D before initiation of Peg-interferon-alpha/ribavirin(Peg IFN/RBV) therapy could improve the efficacy of Peg IFN/RBV in previously null-responder patients with chronic genotype 1 or 4 hepatitis C virus(HCV) infection.METHODS:Genotype 1 or 4 HCV-infected patients with null response to previous Peg IFN/RBV treatment and with hypovitaminosis D(<30 ng/m L)prospectively received cholecalciferol 100000 IU per week for 4 wk[from week-4(W-4)to W0],followed by 100000 IUper month in combination with Peg IFN/RBV for 12 mo(from W0 to W48).The primary outcome was the rate of early virological response defined by an HCV RNA<12 IU/m L after 12 wk Peg IFN/RBV treatment.RESULTS:A total of 32 patients were included,19(59%)and 13(41%)patients were HCV genotype1 and 4,respectively.The median baseline vitamin D level was 15 ng/m L(range:7-28).In modified intention-to-treat analysis,29 patients who received at least one dose of Peg IFN/RBV were included in the analysis.All patients except one normalized their vitamin D serum levels.The rate of early virologic response was 0/29(0%).The rate of HCV RNA<12IU/m L after 24 wk of Peg IFN/RBV was 1/27(4%).The safety profile was favorable.CONCLUSION:Addition of vitamin D to Peg IFN/RBV does not improve the rate of early virologic response in previously null-responders with chronic genotype 1or 4 HCV infection.

The transcontinental variability of nonalcoholic fatty liver disease

Aim:To compare the phenotype of lean versus overweight(OW)and obese(OB)subjects with non-alcoholic fatty liver disease(NAFLD)across multiple continents.Methods:A retrospective study of histologically defined subjects from a single center each in France(Fr),Brazil(Br),India(In)and United States(US)was performed.Results:A total of 70 lean[body mass index(BMI)<25 kg/m2]subjects(Fr:Br:In:US:16:19:22:13)with NAFLD were compared to 136 OW(BMI>25 kg/m2,BMI<29 kg/m2)(n=28:33:52:23)and 224 OB subjects(BMI>29 kg/m2)(n=81:11:22:103).Lean French subjects had the lowest incidence of type 2 diabetes while those from Brazil(P<0.01)had the highest.Lean subjects had similar low-density lipoprotein-cholesterol,but higher high-density lipoprotein-cholesterol compared to obese subjects in all regions.In both lean and obese subjects,there were both insulin-sensitive and insulin-resistant subjects.Lean French subjects were most insulin-sensitive while those from Brazil were mostly insulin-resistant.For each weight category,subjects from India were more insulin-sensitive than those from other regions.Disease activity increased from lean to overweight to obese in France but was similar across weight categories in other regions.Conclusion:The phenotype of NAFLD in lean subjects varies by region.Some obese subjects with NAFLD are insulin-sensitive.We hypothesize that genetics and region-specific disease modifiers account for these differences.