Vitamins? The Magic Bullet Against Hepatitis C

Hans L Tillmann

Disclosures

Expert Rev Anti Infect Ther. 2012;10(11):1273-1277. 

In This Article

Abstract and Introduction

Abstract

Evaluation of: Rocco A, Compare D, Coccoli P et al. Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus. Gut doi:10.1136/gutjnl-2012-302344 (Epub ahead of print) (2012).

Vitamin B12 was first mentioned to have a role in HCV treatment approximately a decade ago, but it has not been well translated into clinical medicine. Recently, however, a randomized trial has reported significantly better response at all time-points during therapy with pegylated interferon plus ribavirin, if such therapy was combined with vitamin B12. This correlates with reports on vitamin B12 being able to inhibit HCV in vitro and a report that vitamin B12 levels were related to treatment response. If further validated, vitamin B12 is another vitamin reported to be beneficial for HCV therapy. Vitamin D had repeatedly been reported to be associated with response to HCV therapy. It will be interesting to see whether vitamins such as B12 and D will remain relevant in the light of direct antivirals.

Introduction

Vitamin B12 was reported to inhibit HCV via internal ribosome entry-site inhibition in the early 2000s,[1–3] but the findings were never confirmed nor rejected by anyone other than the group who published the initial reports. The first and so far only published clinical evaluation of vitamin B12 levels in patients concerning clinically relevant outcome was reported by Swedish investigators in 2011,[4] who described that patients achieving an end of treatment response (ETR) had significantly higher baseline vitamin B12 levels (331 pM in ETR vs 260 pM in nonresponders; p = 0.012) and that ETR was achieved in 25 out of 26 patients (96.2%; 95% CI: 81–99%) with vitamin B12 levels >360, versus 50 out of 73 patients (68.5%; 95% CI: 57–78%) with lower levels. For sustained viral response (SVR), the difference, however, was no longer significantly different (17 out of 26 [65%] vs 38 out of 73 [52%]; p = 0.26).

Prior to that publication on baseline vitamin B12 levels to predict antiviral response, a group in Italy initiated a placebo-controlled study in 2006, to evaluate whether supplemental vitamin B dosing would increase response over 'standard of care' (SOC) for HCV, which consisted of pegylated interferon (Peg-IFN) and ribavirin at that time. The study's report will be reviewed here.

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