TOPIC:

This is a bit train of consciousness stuff, but I wanted to put it somewhere.....

So this post did not start with this link, but I found it later and thought it should start with it:

www.ncbi.nlm.nih.gov/pmc/articles/PMC3953807/

Ok, so that's filed now.

If you read stuff like this:

www.ncbi.nlm.nih.gov/pubmed/23159619

www.pnas.org/content/107/40/17176.full

www.ncbi.nlm.nih.gov/pubmed/16356932

And look at the lifecycle of HCV in this french video fixhepc.com/forum/media-news/506-video-o...irus-life-cycle.html

You will note the following:

1. It travels in the blood in concert with LDL and VLDL (Low Density Lipoprotein) and (Very Low Density Lipoprotein)
2. It likes to have lots of cholesterol in the cell membrane

Which probably explains why STATIN drugs (which reduce cholesterol and "bad cholesterol" aka LDL) increase RVR and SVR rates.

Now you might think Alpha Lipoic Acid is related because of the name, but it's not really. It's an antioxidant that can replenish glutathione stores.

www.ncbi.nlm.nih.gov/pubmed/9378235

Now JAK-STAT and Intereron are involved in HCV immunity

www.ncbi.nlm.nih.gov/pubmed/23587486

And S-Adenosylmethionine and Betaine Correct Hepatitis C Virus Induced Inhibition of Interferon Signaling In Vitro

onlinelibrary.wiley.com/store/10.1002/he...e22267ca381d2bb19ff0

And the mechanism involves restoring reduced glutathione levels (GSH)

And we know B12 is depleted by low glutathione

phoenixrising.me/research-2/glutathione-...rich-von-konynenburg

And we know that B12 helps with RVR and SVR

www.ncbi.nlm.nih.gov/pubmed/22810757

We also know that Vit D deficiency is common in HCV and Vit D has activity against HCV and higher Vit D levels correlate with improved SVR

www.ncbi.nlm.nih.gov/pubmed/21145801

hepatitiscnewdrugresearch.com/vitamin-d-and-treatment.html

So if you wanted to take supplements there is evidence around:

1. B12
2. Vit D (calcitriol)
3. Antioxidants like ALA, S-Adenosylmethionine and Betaine because they increase glutathione and probably work to protect B12 levels and JAK-STAT mediated local Interferon production
4. Statins because they reduce the transporters for the virus in the blood that are essential to getting into liver cells

YMMV but if I was treating for HCV I would be considering each, particularly with GT3 where the SVR rate is ~90%

IF YOU ARE GOING TO TAKE ANY OF THESE SUPPLEMENTS YOUR NEED TO TAKE THEM DURING MEDICATION TREATMENT PERIOD BECAUSE THEIR ROLE IS TO ASSIST THE MEDICATIONS.

With GT1 and 2 cure rates are already really high so it would be hard to demonstrate the difference, but with GT3....

If we can get enough people into REDEMPTION-2 we could do a subanalysis on B12 levels, Vit D levels vs SVR and perhaps the statin question.

Great, with evidence too - Thank-you Dr F .

I had always a problem with the cholesterol, since my 20s . High cholesterol.
This means that it is harder to treat hep C because I 'offer' more transportation for viruses?
Thanks!

This is fascinating. I've just started Sof/Dac treatment and I've been considering taking ALA as I'm concerned that as well as the virus I may have Post-Interferon Syndrome, and there is apparently evidence that ALA can help with this. However I'm worried about taking any supplements due to possible interaction with Daclatasvir. Is ALA safe to take with Dac?

Hi Phoenix,

I have not been a big believer in supplements figuring that if you are fit and well and eat a balanced, varied diet you should get all you need from that without requiring extras. However, recent reading such as the doc's musings above along with further research has me pondering the facts that I am fast approaching the big six-ohh and have probably had chronic hep c for 2/3 of that period! Apparently neither are ideal for helping to extract all the nutrients you need from even the best diet. So I'm taking myself off to my GP for some diagnostics to see where I am lacking and will be giving serious consideration to supplements such as B-complex (+ extra B12?), Betaine, SAMe and now ALA.
For your question, the post above and the references quoted in it don't seem to give any concern of a likely interaction between these items and Dac or Sof. Hope this helps.

<edit> and now vitamin D as well.

How about N-Acetyl Cysteine (NAC)?
It is also a glutathione precursor.
I stopped taking it a while back when I didn't notice any improvement but now that I'm on Twinvir it might help.
I've still got several large unexpired bottles

How about N-Acetyl Cysteine (NAC)?

Hi Tim,

Yes and No.

Theoretically it should do a similar job to ALA, SAMe, and Betaine (and it's worth considering you almost certainly don't need all of these given the final common pathway).

www.hepatitiscentral.com/news/hcv_and_the_bod/

But practically:

1. NAC tends to make people feel sick
2. NAC does not seem to help much

www.ncbi.nlm.nih.gov/pmc/articles/PMC3953807/

However this article did dig up Vitamin D which seems to be usefully active.

www.ncbi.nlm.nih.gov/pubmed/21145801

hepatitiscnewdrugresearch.com/vitamin-d-and-treatment.html

I will edit the original post to include Vit D but not NAC because of the lack of evidence it helps SVR.

Hi Dr F, This post is most helpful indeed.

A question, if you have time?

A good friend is on harvoni, one failed Interferon/Riba prev. tx which has left her with long term health problems .

Does this info apply to those on Riba too?
She has appointment with her UK consultant tomorrow & is suffering low red blood cells.
She will be asking her medical teams advise tomorrow.

Many thanks in advance & best wishes.

Pretty much all the supplements data relates to Interferon+Riba treatment and is being extrapolated into the age of DAAs.

The jury is still out as to their utility with DAAs, but unless we get a 100% pan genotypic combo I would be thinking about normalising LDL cholesterol with a statin and making sure my B12 and vitamin D were high normal. I would probably take an antioxidant too.

But that's just me and YMMV.

Thank you Dr. James,
I'll check for B12. I already know that I have vit D deficit.
My LDL is 149 mg/dL - borderline 130-160 mg/dL
I'll check with my doctor for statin.

But if I understand correctly, statin & B12 supplement & vit D supplement & antioxidant only end of treatment, after 12 weeks of Twinvir.
Am I right?
Thanks!

Hi isaing, I 'think' the B12 article says it could 'aid' SVR - but trial was for Int/Riba ?
so not much literal evidence for DDAs as yet, but Dr F would personally recommend
(hopefully I have got this right!)

Hi LondonGirl,
I know that B12 and vit D supplements were studied for IFN / RIBA.
But where is a deficiency probable is worth taking supplements/vitamins.

My question comes from mentioning aid for SVR and RVR.
So, taking B12 & vit D& statin & antioxidant AFTER and/ or DURING treatment with DAAs.
Thanks again!

And we know that B12 helps with RVR and SVR
www.ncbi.nlm.nih.gov/pubmed/22810757

but the above was a trial on Int/Riba tx - hence :

The jury is still out as to their utility with DAAs, but unless we get a 100% pan genotypic combo I would be thinking about normalising LDL cholesterol with a statin and making sure my B12 and vitamin D were high normal. I would probably take an antioxidant too.

I started to take B12 twice a week, but 4 hours after the Twinvir tablet.

Thank you LondonGirl and Dan,
I avoid all supplements, vitamins and other medication because I am afraid of unknown interactions with Twinvir.
I don't know, maybe is wise after finishing the treatment to consider the all four:
B12 and vit D if there is a deficiency.
Antioxidant] like ALA and statin for ''bad'' LDL cholesterol.