Vitamin-Virus Connection

Have you heard the buzz lately about vitamin B12 and hepatitis C? After a pilot study reported that vitamin B12 improved hepatitis cure rates, some of my patients have been asking whether vitamin B12 injections could up their chances of curing their hepatitis C virus (HCV) infection.  

The recent study I mentioned, which was published in Gut, found a 34 percent increase in HCV sustained viral response rate (e.g., cure) when monthly vitamin B12 injections were added to the standard HCV treatment. This vitamin B12 benefit was most prevalent in carriers of the genotype 1 virus, which happens to be the most common type of HCV in the United States.  

But you might want to hold on before you ask your doctor for a “vitamin B12 shot.” There are reasons to be skeptical of this promising vitamin benefit…and, by training, I am always skeptical: 

    1. The study was based on a small sample of patients, just 94 of them to be precise. Small sample size could lead to bias in any study.  
    2. The study was performed before the new protease inhibitor medications (Victrelis and Incivek) became available as part of the standard treatment regimen for genotype 1 HCV. Now that protease inhibitors are part of the standard treatment for HCV, it is possible that vitamin B12 might not show the same benefits as seen in this study. 

Understanding Vitamin B12

Dietary sources of vitamin B12 include meat, dairy, and fish. This vitamin, which is also called cobalamin, requires adequate amounts of hydrochloric acid in your stomach before it can be released in a usable form from protein-based foods. After it’s released, vitamin B12 then combines with a stomach protein called “intrinsic factor” and is then absorbed by your body.  

As you might imagine, there are several potential stumbling blocks in this vitamin B12 absorption process. Increasing age, alcohol use, and certain diseases and drugs might make vitamin B12 absorption inefficient, so much so that supplementation could be necessary.  

Adding to the problem for HCV patients is the fact that vitamin B12 is stored in your liver – the organ where HCV has been causing damage for years. Perhaps with this disease, you have not been able to adequately store vitamin B12.  

But in order to know for sure if you are falling short with vitamin B12, the best course of action is to talk to your treating doctor. Your doctor can check your vitamin B12 levels and look at your complete blood count (CBC) to see if you have an anemia that warrants vitamin B12 supplementation. It is not prudent to make any changes in your treatment regimen without talking to your doctor who is treating your HCV infection or your pharmacist. 

Experts are interested in the fascinating finding of this study and the simple and inexpensive aid that vitamin B12 might present for HCV patients. However, most agree further study is warranted before recommending that vitamin B12 be routinely given with HCV treatment. Fortunately, this same set of researchers already have a large, randomized, controlled trial planned to confirm the vitamin B12-HCV results of this pilot study. I, for one, will be anxiously awaiting those study results.

Stephen C Vogt, PharmD
President and CEO
BioPlus SP

1. Rocco A, Compare D, Coccoli P, et al. Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus. Gut July 18, 2012. DOI: 10.1136/gutjnl-2012-302344

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