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  • 4 January 2016 at 4:45 pm #7951
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    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:

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

    Ok, so that’s filed now.

    If you read stuff like this:

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

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

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

    And look at the lifecycle of HCV in this french video http://fixhepc.com/forum/media-news/506-video-of-hepatitis-c-virus-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.

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

    Now JAK-STAT and Intereron are involved in HCV immunity

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

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

    http://onlinelibrary.wiley.com/store/10.1002/hep.21116/asset/21116_ftp.pdf;jsessionid=AB76D20D603D4C1358F6F7E9A4E02801.f01t03?v=1&t=iizxv9cs&s=deda7a9590e8c638e040e22267ca381d2bb19ff0

    And the mechanism involves restoring reduced glutathione levels (GSH)

    And we know B12 is depleted by low glutathione

    http://phoenixrising.me/research-2/glutathione-depletionmethylation-blockades-in-chronic-fatigue-syndrome/a-simple-explanation-of-the-glutathionemethylation-depletion-theory-of-mecfs-by-rich-von-konynenburg

    And we know that B12 helps with RVR and SVR

    http://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

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

    http://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.

    YMMV

    4 January 2016 at 5:34 pm #7955
    Avatar photoLondonGirl
    • Guardian Angel
    • ★★★★★
    @londongirl

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

    GT1a Dec14 F2/8.7 VL 900000-2.5M
    Jan16 Hepcivir-L MonkMed/Redemption
    Baseline: VL 913575 Alt 76 Platelets low
    Wk2 VL1157 Alt 23
    DET Wk 8 VL 32 Alt19 ‘In the slow lane’
    June16 Fibro 5.7 F0/1 LIF 1.5
    Wk 11 VL<12 Alt 13 Det/Unq
    Extending tx 12 wks Mylan Sofo/Dac MonkMed
    Wk 14 VL <12 Det/Unq
    Wk 16 VL UNDETECTED
    Wk 22 + 4 Wks Sunprevir FixHepC
    Wk 24 UNDETECTED Alt 13
    Wk 12 post tx SVR12 Wk 26 SVR24
    Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC

    4 January 2016 at 7:13 pm #7974
    Avatar photoisaing4
    • Guardian Angel
    • ★★★★★
    @isaing4

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

    HCV since I don’t know. Diagnosed in 2010.
    GT1b, F0/F1, VL 9M, ALT 44, AST 42, Tx naive,
    started 12 wks Twinvir on 06.12.2015. Feeling great and grateful 🙂
    virus not detected 06.02.2016 & SVR24
    isaing4@gmail.com

    5 January 2016 at 2:30 am #8004
    Avatar photoPhoenix
    • Topics: 12
    • Replies: 60
    • Total: 72
    • Recovery Champion
    • ★★★★
    @phoenix

    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?

    5 January 2016 at 3:26 am #8007
    avatar876.jpegGaj
    • Guardian Angel
    • ★★★★★
    @gaj

    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.

    and now vitamin D as well. :)

    G3a since ’78 – Dx ’12 – F4 (2xHCC)
    24wk Tx – PEG/Riba/Dac 2013 relapsed
    24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
    16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
    SVR7 – 22/06/17 UND
    SRV12 – 27/07/17 UND
    SVR24 – 26/10/17 UND
    :cheer: :cheer: :cheer:

    5 January 2016 at 4:03 am #8008
    Tim-Naylor-google
    • Topics: 1
    • Replies: 11
    • Total: 12
    • Acolyte
    • ★★
    @tim-naylor-google

    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

    GT1 F4 compensated, I/F non-responder 1997
    @2015-11-06 VL 3.5 x 10^6, started Twinvir
    @2015-12-31 VL:UND
    @2016-01-29 started 2nd 12 weeks of Twinvir
    @2016-03-01 ALT=42 AST=42, other LFT in normal range

    5 January 2016 at 4:36 am #8009
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    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).

    HCV and the Body's Most Important Antioxidant

    But practically:

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

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

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

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

    http://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.

    YMMV

    5 January 2016 at 3:51 pm #8037
    Avatar photoLondonGirl
    • Guardian Angel
    • ★★★★★
    @londongirl

    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.

    GT1a Dec14 F2/8.7 VL 900000-2.5M
    Jan16 Hepcivir-L MonkMed/Redemption
    Baseline: VL 913575 Alt 76 Platelets low
    Wk2 VL1157 Alt 23
    DET Wk 8 VL 32 Alt19 ‘In the slow lane’
    June16 Fibro 5.7 F0/1 LIF 1.5
    Wk 11 VL<12 Alt 13 Det/Unq
    Extending tx 12 wks Mylan Sofo/Dac MonkMed
    Wk 14 VL <12 Det/Unq
    Wk 16 VL UNDETECTED
    Wk 22 + 4 Wks Sunprevir FixHepC
    Wk 24 UNDETECTED Alt 13
    Wk 12 post tx SVR12 Wk 26 SVR24
    Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC

    5 January 2016 at 5:08 pm #8045
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    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.

    YMMV

    5 January 2016 at 5:42 pm #8049
    Avatar photoisaing4
    • Guardian Angel
    • ★★★★★
    @isaing4

    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! :lol:

    HCV since I don’t know. Diagnosed in 2010.
    GT1b, F0/F1, VL 9M, ALT 44, AST 42, Tx naive,
    started 12 wks Twinvir on 06.12.2015. Feeling great and grateful 🙂
    virus not detected 06.02.2016 & SVR24
    isaing4@gmail.com

    5 January 2016 at 5:54 pm #8050
    Avatar photoLondonGirl
    • Guardian Angel
    • ★★★★★
    @londongirl

    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!)

    GT1a Dec14 F2/8.7 VL 900000-2.5M
    Jan16 Hepcivir-L MonkMed/Redemption
    Baseline: VL 913575 Alt 76 Platelets low
    Wk2 VL1157 Alt 23
    DET Wk 8 VL 32 Alt19 ‘In the slow lane’
    June16 Fibro 5.7 F0/1 LIF 1.5
    Wk 11 VL<12 Alt 13 Det/Unq
    Extending tx 12 wks Mylan Sofo/Dac MonkMed
    Wk 14 VL <12 Det/Unq
    Wk 16 VL UNDETECTED
    Wk 22 + 4 Wks Sunprevir FixHepC
    Wk 24 UNDETECTED Alt 13
    Wk 12 post tx SVR12 Wk 26 SVR24
    Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC

    5 January 2016 at 6:17 pm #8051
    Avatar photoisaing4
    • Guardian Angel
    • ★★★★★
    @isaing4

    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. :unsure:
    Thanks again!
    :cheer:

    HCV since I don’t know. Diagnosed in 2010.
    GT1b, F0/F1, VL 9M, ALT 44, AST 42, Tx naive,
    started 12 wks Twinvir on 06.12.2015. Feeling great and grateful 🙂
    virus not detected 06.02.2016 & SVR24
    isaing4@gmail.com

    5 January 2016 at 6:30 pm #8052
    Avatar photoLondonGirl
    • Guardian Angel
    • ★★★★★
    @londongirl

    And we know that B12 helps with RVR and SVR
    http://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.

    GT1a Dec14 F2/8.7 VL 900000-2.5M
    Jan16 Hepcivir-L MonkMed/Redemption
    Baseline: VL 913575 Alt 76 Platelets low
    Wk2 VL1157 Alt 23
    DET Wk 8 VL 32 Alt19 ‘In the slow lane’
    June16 Fibro 5.7 F0/1 LIF 1.5
    Wk 11 VL<12 Alt 13 Det/Unq
    Extending tx 12 wks Mylan Sofo/Dac MonkMed
    Wk 14 VL <12 Det/Unq
    Wk 16 VL UNDETECTED
    Wk 22 + 4 Wks Sunprevir FixHepC
    Wk 24 UNDETECTED Alt 13
    Wk 12 post tx SVR12 Wk 26 SVR24
    Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC

    5 January 2016 at 7:56 pm #8059
    Avatar photoDan
    • Guardian Angel
    • ★★★★★
    @dan

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

    Gen 1b, F1-F2. Naive.
    Started Twinvir tx on 2 nd of December 2015 for 12 weeks.
    Starting VL 400000, Alt 49/AST 44
    1 week VL 29, ALT 44/AST 30.
    4 weeks VL 12, ALT 33, Platelets 145, all other tests normal.
    7 weeks VL Detected, ALT 28, all other normal
    8 weeks UND, 12 week UND, 24 week SVR UND

    5 January 2016 at 8:45 pm #8062
    Avatar photoisaing4
    • Guardian Angel
    • ★★★★★
    @isaing4

    Thank you LondonGirl and Dan,
    I avoid all supplements, vitamins and other medication because I am afraid of unknown interactions with Twinvir. :woohoo:
    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.

    :lol:

    HCV since I don’t know. Diagnosed in 2010.
    GT1b, F0/F1, VL 9M, ALT 44, AST 42, Tx naive,
    started 12 wks Twinvir on 06.12.2015. Feeling great and grateful 🙂
    virus not detected 06.02.2016 & SVR24
    isaing4@gmail.com

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