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Vitamin B12 Benefits Those with Chronic Hepatitis C

Vitamin B12 benefits hepatitis C

Chronic hepatitis C virus infection is a major health problem, affecting approximately 3.2 million people in the United States and 170 million around the world. The prognosis for the disease is not good, but a new study has found that taking vitamin B12 as part of standard treatment for chronic hepatitis C can significantly benefit patients.

How to fight hepatitis C with a vitamin

Chronic hepatitis C is a relentless disease that develops in between 60% and 80% of individuals who are infected with hepatitis C virus. Approximately one-third of patients with chronic hepatitis C can expect to progress to cirrhosis (scarring of the liver and the final phase of liver disease) or terminal liver disease.

According to a recent study conducted by the Centers for Disease Control and Prevention (CDC), death rates from hepatitis C are rising. A surprising three-quarters of the deaths are among people ages 45 to 64 years of age.

Treating chronic hepatitis C can be a costly endeavor, weighing in at tens of thousands of dollar per year, depending on the severity of the disease. A Stanford University study published in early 2012 found that triple therapy (pegylated interferon with ribavirin [standard therapy] plus a protease inhibitor) has a high price tag, although less expensive than a liver transplant, which can cost well over $100,000.

The new study, which appears in the current issue of Gut, presents the results of the use of a safe and inexpensive add-on treatment option for patients with chronic hepatitis C and a way to enhance their response to antiviral drugs.

In this pilot study, the authors found that the addition of vitamin B12 to standard treatment significantly enhanced the body's ability to keep the virus at bay. This benefit was especially impressive in individuals who had infections that were challenging to treat.

Standard treatment includes pegylated interferon, a chemically altered form of interferon used to treat hepatitis C. The PEG portion of the drug refers to a molecule called polyethylene glycol, which helps the interferon stay in the body longer.

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Ribavirin is used along with pegylated interferon and works by stopping the virus that causes hepatitis C from spreading inside the body. Together, these drugs can clear the virus in about half of patients who are infected with genotype 1 HCV and 80% of those with genotypes 2 or 3.

The vitamin B12 study
Although there has been evidence for more than a decade that vitamin B12 directly inhibits the replication of hepatitis C virus, this pilot study was the first to evaluate whether vitamin B12 supplementation might help in the treatment of HCV-related chronic diseases.

The study involved 94 patients with chronic hepatitis C who were randomly assigned to received standard treatment or standard treatment plus 5,000 micrograms of vitamin B12 delivered intramuscularly every 4 weeks for between 24 weeks (for genotypes 2 and 3) and 48 weeks (genotype 1).

Although there was no difference after 4 weeks with the ability of the body to clear the virus, there was a significant difference at 12 weeks and 24 weeks. The difference was significantly greater for patients who had the type 1 strain, which is especially hard to treat, and among patients who had a high level of infection at the start of the study.

Overall, the addition of vitamin B12 to standard therapy improved sustained viral response by 34% overall.

The authors acknowledged that their study did not have a placebo arm and that the number of patients was limited. Therefore, "the results should be interpreted with due caution."

However, vitamin B12 is an inexpensive treatment option that has demonstrated some benefit in patients with chronic hepatitis C. The authors pointed out that "this strategy would be especially useful in those countries where, owing to limited economic means, the new generation antiviral therapies cannot be given in routine practice." Given its low cost, one would hope vitamin B12 could be considered for anyone who has chronic hepatitis C, no matter where they lived.

Liu S et al. New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis. Annals of Internal Medicine 2012 Feb 21; 156(4)
Rocco A et al. Vitamin B12 supplementation improves rates of sustained viral repsonse in patients chronically infected with hepatitis C virus. Gut 2012. doi:10.1136/gutjnl-2012-302344

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