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. 2017 Mar 4;4(1):e000115.
doi: 10.1136/bmjgast-2016-000115. eCollection 2017.

Effect of season and sunlight on viral kinetics during hepatitis C virus therapy

Noemi Hernández-Alvarez  1 , Juan Manuel Pascasio Acevedo  2 , Enrique Quintero  1 , Inmaculada Fernández Vázquez  3 , María García-Eliz  4 , Juan de la Revilla Negro  5 , Javier Crespo García  6 , Manuel Hernández-Guerra  1
Affiliations

Effect of season and sunlight on viral kinetics during hepatitis C virus therapy

Noemi Hernández-Alvarez et al. BMJ Open Gastroenterol. .

Abstract

Background and aims: Rapid viral response (RVR) during antiviral treatment for hepatitis C virus (HCV) predicts sustained viral response (SVR). Recently, vitamin D levels have been associated with SVR. As sunlight is the most important source of vitamin D and shows seasonal variation, we evaluated the effect of season on viral kinetics during peginterferon/ribavirin-based therapy for HCV.

Methods: Consecutive HCV patients treated with peginterferon/ribavirin and boceprevir/ telaprevir (June 2011-July 2014) were included. Patients were grouped according to season when therapy was initiated (Season A: May-October and Season B: November-April) depending on hours of daily sunlight. Multiple logistic regression analysis included factors known to influence SVR to treatment. The dependent variables were undetectable viral load (VL) or VL ≤15 UI/mL (VL ≤15) at weeks 4, 8 and 12, end of treatment and SVR.

Results: The study included 930 patients (66.8% men; median 54 years) treated with telaprevir (n=537) or boceprevir, without (n=481) or with lead-in therapy of peginterferon/ribavirin. Baseline characteristics of patients in Season A (45.3%, n=421) and Season B groups were similar. Overall, a higher rate of RVR (23.5% vs 16.1%, p=0.005) and VL ≤15 (51.0% vs 38.6%, p≤0.001) was observed in patients starting treatment during Season A versus Season B. By logistic regression analysis, initiating treatment in Season A proved to be an independent predictor of RVR and VL ≤15.

Conclusions: In our setting, seasonality affects viral kinetics in HCV genotype 1 patients treated with peginterferon/ribavirin-based therapy. Our findings support the hypothesis that vitamin D influences viral response to peginterferon/ribavirin-based therapy.

Keywords: ANTIVIRAL THERAPY; CHRONIC HEPATITIS; HEPATITIS C; VITAMIN D RECEPTOR GENE.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Number of hours of sunlight per month in 2012 according to geographical area (Northern, Central and Southern Spain). Data modified from original source available at: http://www.aemet.es/documentos_d/conocermas/biblioteca/calendarios/cm-2013.pdf.
Figure 2
Figure 2
Schematic representation of patients included in the study according to geographical area. Grey crosses represent patients starting treatment during Season A (May–October) and red circles represent patients starting treatment during Season B (November–April).
Figure 3
Figure 3
Seasonal variation of vitamin D. Vitamin D levels oscillated during the year depending on the season. The months of Season A (May–October) are shaded in grey.
See this image and copyright information in PMC

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