Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus
- Alba Rocco1,
- Debora Compare1,
- Pietro Coccoli1,
- Ciro Esposito2,
- Antimo Di Spirito2,
- Antonio Barbato3,
- Pasquale Strazzullo3,
- Gerardo Nardone1
- 1Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
- 2Unit of Virology, “D. Cotugno” Hospital, Naples, Italy
- 3Internal Medicine Unit, University of Naples “Federico II”, Naples, Italy
- Correspondence to Professor Gerardo Nardone, Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, via Pansini 5, 80131 Naples, Italy;
Contributors AR, DC, GN: study concept and design and drafting of the manuscript. AR, DC, PC, CE, ADS: acquisition of data. AR, AB: analysis and interpretation of data; statistical analysis. PS, GN: critical revision of the manuscript for important intellectual content.
- Revised 5 June 2012
- Accepted 6 June 2012
- Published Online First 17 July 2012
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.
Conclusion Vitamin B12 supplementation significantly improves SVR rates in HCV-infected patients naïve to antiviral therapy.
- Vitamin B12
- chronic hepatitis C
- response to treatment
- 13C-urea breath test
- breath tests
- celiac disease
- gastric adenocarcinoma
- helicobacter pylori
- gastric metaplasia
- gastric cancer
Competing interests None.
Ethics approval Ethical Committee University Federico II of Naples.
Provenance and peer review Not commissioned; externally peer reviewed.