Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus.
BACKGROUND
In vitro, vitamin B12 acts as a natural inhibitor of hepatitis C virus (HCV) replication.


OBJECTIVE
To assess the effect of vitamin B12 on virological response in patients with chronic HCV hepatitis naïve to antiviral therapy.


METHODS
Ninety-four patients with chronic HCV hepatitis were randomly assigned to receive pegylated interferon α plus ribavirin (standard-of-care; SOC) or SOC plus vitamin B12 (SOC+B12). Viral response-namely, undetectable serum HCV-RNA, was evaluated 4 weeks after starting treatment (rapid viral response), 12 weeks after starting treatment (complete early viral response) and 24 or 48 weeks after starting treatment (end-of-treatment viral response) and 24 weeks after completing treatment (sustained viral response (SVR)). Genotyping for the interleukin (IL)-28B polymorphism was performed a posteriori in a subset (42/64) of HCV genotype 1 carriers.


RESULTS
Overall, rapid viral response did not differ between the two groups, whereas the rates of complete early viral response (p=0.03), end-of-treatment viral response (p=0.03) and SVR (p=0.001) were significantly higher in SOC+B12 patients than in SOC patients. In SOC+B12 patients, the SVR rate was also significantly higher in carriers of a difficult-to-treat genotype (p=0.002) and in patients with a high baseline viral load (p=0.002). Distribution of genotype IL-28B did not differ between the two groups. At multivariate analysis, only easy-to-treat HCV genotypes (OR=9.00; 95% CI 2.5 to 37.5; p=0.001) and vitamin B12 supplementation (OR=6.9; 95% CI 2.0 to 23.6; p=0.002) were independently associated with SVR.


CONCLUSIONS
Vitamin B12 supplementation significantly improves SVR rates in HCV-infected patients naïve to antiviral therapy.
Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy.
Alba
A
Rocco
Debora
D
Compare
Pietro
P
Coccoli
Ciro
C
Esposito
Antimo
A
Di Spirito
Antonio
A
Barbato
Pasquale
P
Strazzullo
Gerardo
G
Nardone
D000328:Adult; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011092:Polyethylene Glycols; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014803:Vitamin B Complex / Q000627:therapeutic use*
D000998:Antiviral Agents; D016898:Interferon-alpha; D014803:Vitamin B Complex; D011092:Polyethylene Glycols; D014805:Vitamin B 12