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Semin Liver Dis 2011; 31(4): 387-398
DOI: 10.1055/s-0031-1297927
© Thieme Medical Publishers

Classical and Emerging Roles of Vitamin D in Hepatitis C Virus Infection

Julio A. Gutierrez1 , Neil Parikh2 , Andrea D. Branch2
  • 1Division of Gastroenterology, University of California, San Diego, California
  • 2Division of Liver Diseases, The Mount Sinai School of Medicine, New York, New York
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Publication History

Publication Date:
21 December 2011 (online)

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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

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