The efficacy of adding vitamin B12 to pegylated interferon and ribavirin treatment in Hepatitis C virus patients regarding the host and viral prognostic factors

Abstract

Introduction: Hepatitis C virus (HCV) infection affects almost 180 million people around the world. Even though the development of direct acting antivirals (DAAs) has significantly improved the treatment responses to HCV infection, treatment with pegylated interferon (PegIFN) in combination with ribavirin is considered the standard of care (SOC) for chronic HCV infection treatment in countries with limited medical resources. Considering the inhibitory effect of vitamin B12 on HCV replication, we have evaluated the effect of vitamin B12 supplementation along with SOC on treatment outcomes in patients with chronic HCV infection, who were antiviral treatment-naive.
 Methods: In this regard, seventy-four HCV-infected patients, naïve to antiviral therapy, were randomly assigned to receive SOC or SOC in addition to vitamin B12 (SOC + B12). Viral response was evaluated at 4, 12, 24 and 48 weeks following the initiation of viral treatment and at 24 weeks after completing the treatment. Genotyping of the interleukin 28B (IL28B) polymorphisms was also performed. Demographic characteristics, clinical findings, fibroscan results and drug adverse effects were recorded.
 Results: Our findings showed that rapid viral response was not significantly different between the two groups; however, the rates of complete early viral response (cEVR) (p=0.033), end-of-treatment viral response (ETVR) (p=0.001) and sustained virologic response (SVR) (p=0.0001) were significantly higher in SOC + B12 patients compared to SOC patients. Besides, in SOC + B12 patients, those with a higher baseline viral load and carriers of IL28B CC genotype showed significantly higher rate of SVR.
 Conclusion: In conclusion, the addition of vitamin B12 significantly improved the rate of SVR in HCV-infected patients, who were naïve to antiviral therapy. As this treatment regimen is safe and inexpensive, it proposes an option for improving the effectiveness of the HCV treatment with SOC, particularly in resource-limited settings.

A comprehensive review on nutritional interventions and nutritive elements: Strengthening immunity for effective defense mechanism during pandemic

“…Although the occurrence of direct affective antiviral (DAA) therapy has remarkably maintained the cure response to hepatitis HCV infection, cure with pegylated interferon together with ribavirins is the quality of care (SOC) for the treatment of chronic HCV infections in the world with mixed medical facilities. Considering the barrier effect of B‐complex vitamins on HCV multiplication, cyanocobalamin supplementation has been found to be very effective in the treatment of patients with chronic HCV infection (Mokhtare et al., 2019 ). Therefore, we can conclude that regularly supplementing diets with vitamins in adequate amounts can enhance the body's natural defense mechanism against harmful toxic and viral agents by boosting the immune response (Aslam et al., 2017 ).…”

The Role of Micronutrients in the Infection and Subsequent Response to Hepatitis C Virus

“…Supporting the beneficial role of baseline vitamin B12, serum homocysteine levels are reduced (<16 µmol/L) in responders to pegylated IFN plus ribavirin therapy [141]. Homocysteine accumulates with vitamin B12 deficiency, and is considered a sensitive indicator of vitamin B12 levels [142].…”