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Homocysteine levels and sustained virological response to pegylated‐interferon α2b plus ribavirin therapy for chronic hepatitis C: a prospective study
Author(s) -
Borgia Guglielmo,
Gentile Ivan,
Fortunato Giuliana,
Borrelli Francesco,
Borelli Salvatore,
De Caterina Maurizio,
Di Taranto Maria Donata,
Simone Maria,
Borgia Federico,
Viola Chiara,
Reynaud Laura,
Cerini Raimondo,
Sacchetti Lucia
Publication year - 2009
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2008.01832.x
Subject(s) - methylenetetrahydrofolate reductase , ribavirin , medicine , gastroenterology , homocysteine , pegylated interferon , odds ratio , hepatitis c virus , immunology , genotype , biology , virus , biochemistry , gene
Background: Chronic hepatitis C affects about 3% of the world's population. Pegylated interferon (IFN) α plus ribavirin is the gold standard treatment. Methylenetetrahydrofolate reductase(MTHFR) is a key enzyme in the metabolism of homocysteine. MTHFR gene polymorphisms and high levels of homocysteine are associated with a high degree of steatosis and fibrosis, conditions associated with a low sustained virological response (SVR) rate. Aims: To evaluate whether MTHFR polymorphisms and homocysteine levels are predictors of the outcome of treatment in 102 prospectively enrolled patients with chronic hepatitis C naive to treatment. Methods: Patients were treated with pegylated interferon α‐2b plus ribavirin. All patients underwent blood tests, assessment of homocysteine, vitamin B 12 , folate, hepatitis C virus (HCV)‐RNA levels, screening for MTHFR gene polymorphisms and liver ultrasound examination. Results: Homocysteine levels were deranged (>16 μmol/L) in 10.5% of MTHFR wild‐type patients vs 40.3% of non‐wild‐type patients ( P =0.015). Homocysteine levels were 14.4 μmol/L in SVR patients and 15.5 μmol/L in non‐SVR patients ( P =0.049). The SVR rate was 40.0% in MTHFR wild‐type patients, 52.0% in heterozygote mutants and 39.3% in homozygote mutants ( P =0.467). At logistic regression analysis, genotypes 2 and 3 (odds ratio: 12.328, 95% confidence interval: 3.390–44.837, P =0.0001), homocysteine <16 μmol/L (odds ratio: 3.397, 95% confidence interval: 1.033–11.177, P =0.044) and aspartate aminotransferase (AST) levels <48 U/L (odds ratio: 3.262, 95% confidence interval: 1.125–9.458, P =0.029) were independent predictors of SVR. Conclusions: In patients with chronic hepatitis C, homocysteine levels are associated with the outcome of pegylated‐IFNα plus ribavirin treatment, while polymorphisms of MTHFR are not.