title: Association between vitamin D and hepatitis C virus infection: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the association between 25-hydroxyvitamin D [25(OH)D] and sustained virological response (SVR) in hepatitis C virus (HCV) infected individuals.
  
  
  METHODS
  Relevant studies were identified by systematically searching MEDLINE databases up to March 2012 and abstracts of the European and American Congress of Hepatology conducted in 2011. Studies must provide information on SVR and the levels of 25(OH)D₃ and/or 25(OH)D₂ [henceforth referred to as 25(OH)D] in sera samples from HCV infected individuals. The inclusion criteria were: clinical studies that included HCV infected patients aged older than 18 years regardless of HCV genotype or ethnic group; provided information on SVR rates; and were reported in the English language as full papers. Due to the heterogeneity of studies in categorizing serum vitamin D levels, a cut-off value of 30 ng/mL of serum 25(OH)D was used. Heterogeneity was assessed using I² statistics. The summary odds ratios with their corresponding 95%CI were calculated based on a random-effects model.
  
  
  RESULTS
  Overall, 11 studies (8 observational and 3 interventional) involving 1575 individuals were included and 1117 HCV infected individuals (71%) showed low vitamin D levels. Most of the studies included mono-infected HCV individuals with the mean age ranging from 38 to 56 years. Four studies were conducted in human immunodeficiency virus/HCV infected individuals. Regarding vitamin D measurement, most of the studies employed radioimmunoassays (n = 5) followed by chemiluminescence (n = 4) and just one study employed high performance/pressure liquid chromatography (HPLC). Basal vitamin D levels varied from 17 to 43 ng/mL in the studies selected, and most of the HCV infected individuals had genotype 1 (1068/1575) with mean viral load varying from log 4.5-5.9 UI/mL. With regard to HCV treatment, most of the studies (n = 8) included HCV individuals without previous treatment, where the pooled SVR rate was 46.4%. High rates of SVR were observed in HCV individuals with vitamin D levels above 30 ng/mL (OR = 1.57; 95%CI: 1.12-2.2) and those supplemented with vitamin D (OR = 4.59; 95%CI: 1.67-12.63) regardless of genotype.
  
  
  CONCLUSIONS
  Our results demonstrated high prevalence of vitamin D deficiency and high SVR in individuals with higher serum vitamin D levels or receiving vitamin D supplementation.
authors.affiliation: Livia Melo Villar, Elisabeth Lampe, Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ 210360-040, Brazil.
authors.forename: Livia Melo
authors.initials: LM
authors.lastname: Villar
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Del Campo
authors.forename: Isidora
authors.initials: I
authors.lastname: Ranchal
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lampe
authors.forename: Manuel
authors.initials: M
authors.lastname: Romero-Gomez
mesh_terms: D015652:25-Hydroxyvitamin D 2 / Q000097:blood* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D019587:Dietary Supplements; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load; D014808:Vitamin D Deficiency / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D015652:25-Hydroxyvitamin D 2; D002112:Calcifediol
keywords: Hepatitis C; Meta-analysis; Sustained virological response; Therapy; Vitamin D