ascorbic-acid and Hepatitis-C--Chronic

To investigate the efficacy of Viusid, a nutritional supplement, as an antioxidant and an immunomodulator in patients with chronic hepatitis C.. Sixty patients with chronic hepatitis C who were non-responders to standard antiviral treatment were randomly assigned to receive Viusid (3 sachets daily, n = 30) or placebo (n = 30) for 24 wk. The primary outcome was the change in serum malondialdehyde and 4-hydroxyalkenals (lipid peroxidation products). Secondary outcomes were changes in serum tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and interleukin-10 (IL-10).. Statistically significant reductions in serum 4-hydroxyalkenals and malondialdehyde levels were observed in both groups in comparison with pretreatment values, but the patients who received Viusid showed a more marked reduction as compared with the control group (P = 0.001). TNF-alpha levels significantly increased from 6.9 to 16.2 pg/mL (P < 0.01) in the patients who received placebo in comparison with almost unchanged levels, from 6.6 to 7.1 pg/mL (P = 0.26), in the patients treated with Viusid (P = 0.001). In addition, IL-10 levels were markedly increased in the patients treated with Viusid (from 2.6 to 8.3 pg/mL, P = 0.04) in contrast to the patients assigned to placebo (from 2.8 to 4.1 pg/mL, P = 0.09) (P = 0.01). Likewise, the administration of Viusid markedly increased mean IFN-gamma levels from 1.92 to 2.89 pg/mL (P < 0.001) in comparison with a reduction in mean levels from 1.80 to 1.68 pg/mL (P = 0.70) in the placebo group (P < 0.0001). Viusid administration was well tolerated.. Our results indicate that treatment with Viusid leads to a notable improvement of oxidative stress and immunological parameters in patients with chronic hepatitis C.

Topics: Antioxidants; Ascorbic Acid; Cytokines; Dietary Supplements; Female; Glycyrrhizic Acid; Hepatitis C, Chronic; Humans; Immunologic Factors; Lipid Peroxidation; Male; Malondialdehyde; Middle Aged; Oxidative Stress; Pantothenic Acid; Placebos; Plant Extracts; Treatment Outcome; Vitamin B 12 Deficiency; Vitamin B 6; Zinc

We investigated the effects of zinc supplementation on clinical observations in chronic hepatitis C patients receiving pegylated interferon (PEG-IFN) alpha-2b plus ribavirin combination therapy. Patients were randomly allocated to receive 150 mg polaprezinc (zinc group, n=11) or no supplement (control group, n=12) daily in addition to PEG-IFN alpha-2b plus ribavirin therapy and 300 mg vitamin E and 600 mg vitamin C supplementation daily for 48 wk. Among the patients who continued treatment, the serum alanine aminotransferase (ALT) level at 12 wk in the zinc group was significantly lower than that in the control group. All patients in the zinc group (9/9) and 67% (8/12) of the control patients at 24 wk, and all patients in the zinc group (7/7) and 60% (6/10) of the control patients at 48 wk showed a decrease in serum ALT levels to within the normal range (7-44 U/L). HCV RNA disappeared in all patients (7/7) in the zinc group and in 8 of 10 control patients at 48 wk. Polaprezinc supplementation decreased plasma thiobarbituric acid reactive substances and prevented the decrease of polyunsaturated fatty acids of erythrocyte membrane phospholipids. No significant differences were observed in the dosage of medicines or other clinical data during the treatment. These observations indicate that polaprezinc supplementation may have induced some antioxidative functions in the liver which resulted in reduced hepatocyte injury during PEG-IFN alpha-2b plus ribavirin therapy.

Topics: Alanine Transaminase; Antiviral Agents; Ascorbic Acid; Carnosine; Dietary Supplements; Drug Therapy, Combination; Fatty Acids, Unsaturated; Female; Flow Cytometry; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Organometallic Compounds; Polyethylene Glycols; Recombinant Proteins; Ribavirin; Thiobarbituric Acid Reactive Substances; Time Factors; Transaminases; Treatment Outcome; Vitamin E; Vitamins; Zinc; Zinc Compounds

We investigated the effects of vitamin E and C supplementation on the fatty acid composition of mononuclear cells and on the clinical observations in patients who had chronic hepatitis C and received interferon-alpha-2b (IFN-alpha-2b) and ribavirin combination therapy.. Patients were randomly allocated to receive daily 500 mg of vitamin E and 750 mg of vitamin C (vitamin group, n = 14) or no supplement (non-vitamin group, n = 16) in addition to IFN-alpha-2b and ribavirin therapy. The fatty acid composition of mononuclear cell phospholipids was analyzed before and at 2, 4, and 8 wk after treatment.. After vitamin supplementation, plasma and red blood cell alpha-tocopherol and plasma ascorbic acid levels increased in the vitamin group. Serum levels of alanine aminotransferase decreased significantly after 2 wk of treatment in both groups. At the start of treatment, a lower level of eicosapentaenoic acid (EPA) and a higher level of the molar ratio of arachidonic acid to EPA in mononuclear cells were observed in the present patients compared with healthy volunteers, and a significant correlation between the molar ratio and serum alanine aminotransferase level was found. The EPA level of mononuclear cells was maintained in the vitamin group during treatment, whereas a significant decrease was observed in the non-vitamin group at 4 and 8 wk after treatment.. Antioxidant vitamin supplementation during IFN-alpha-2b and ribavirin therapy prevented a decrease in EPA of mononuclear cell phospholipids. If a further decrease in the ratio of arachidonic acid to EPA can be achieved by using oral EPA supplementation, the efficacy of IFN-alpha-2b and ribavirin therapy may be improved.

Topics: Alanine Transaminase; Antiviral Agents; Ascorbic Acid; Dietary Supplements; Drug Synergism; Drug Therapy, Combination; Eicosapentaenoic Acid; Fatty Acids, Unsaturated; Female; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Leukocytes, Mononuclear; Male; Middle Aged; Recombinant Proteins; Ribavirin; Treatment Outcome; Viral Load; Vitamin E; Vitamins

Oxidative damage of the erythrocyte membrane plays an important role in ribavirin-induced anemia. The purpose of the present paper was to assess whether supplementation of alpha-tocopherol and ascorbic acid (vitamins) causes changes in the erythrocyte membrane fatty acid composition during interferon and ribavirin combination therapy for chronic hepatitis C patients.. Fatty acid compositions in erythrocyte membrane phospholipids were determined by gas chromatography at 0, 2, 4, 8 weeks, and at the end of combination therapy (26 weeks) for interferon with ribavirin in 32 patients with chronic hepatitis C who were randomized to receive vitamins or not (controls).. Good compliance with orally administered vitamins and ribavirin were confirmed by their concentrations in erythrocytes or plasma. The hemoglobin level was negatively correlated with the ribavirin concentration at 8 weeks (r = 0.59, P = 0.01) after initiation of therapy in controls, but not in the vitamin group. Among the 26 kinds of fatty acids analyzed, only eicosapentaenoic acid (EPA) significantly decreased at 8 weeks after initiation of therapy (P = 0.03) and at the end of therapy (P = 0.004) in controls. Vitamins did not inhibit ribavirin-induced anemia, but attenuated the decrease of EPA in erythrocytes. The EPA level was negatively correlated with the drop in hemoglobin levels at 8 weeks after initiation of therapy in controls (r = 0.58, P = 0.015), but not in the vitamin group.. Supplementation of alpha-tocopherol and ascorbic acid attenuates the ribavirin-induced decrease of EPA in erythrocyte membrane phospholipids in chronic hepatitis C patients.

Topics: alpha-Tocopherol; Ascorbic Acid; Drug Therapy, Combination; Eicosapentaenoic Acid; Erythrocyte Membrane; Female; Hepatitis C, Chronic; Humans; Liver Function Tests; Male; Middle Aged; Ribavirin; Treatment Outcome

To assess the effect of antioxidant supplementation on hepatitis C viral load, transaminases and oxidative status.. We performed a randomized, placebo-controlled, double-blind trial to assess the effect of antioxidant supplementation on serum alanine aminotransferase, plasma hepatitis C viral load as well as oxidative and antioxidant markers in patients with hepatitis C virus infection. The participants received a daily dose of ascorbic acid (500 mg), D-alpha-tocopherol (945 IU) and selenium (200 microg) or placebo tablets for 6 months.. Twenty-three patients were included. During supplementation, the antioxidant group had significantly higher levels of plasma ascorbic acid and alpha-tocopherol than the placebo group and the activity of erythrocyte glutathione peroxidase had significantly increased from baseline to month 6. No differences were observed in serum alanine aminotransferase and log10-transformed plasma hepatitis C virus-RNA between the groups or changes from the baseline at any time. No consistent differences between groups or changes from the baseline with respect to erythrocyte activities of antioxidative enzymes (glutathione reductase, superoxide dismutase and catalase) or plasma levels of oxidative markers (malondialdehyde and 2-amino-adipic semialdehyde) were found.. Supplementation with vitamin C, E and selenium increased the antioxidant status, but had no effects on alanine aminotransferase, viral load or oxidative markers.

Topics: Adult; Alanine Transaminase; Antioxidants; Ascorbic Acid; Biomarkers; Double-Blind Method; Female; Hepatitis C, Chronic; Humans; Male; Middle Aged; Selenium; Viral Load; Vitamin E

Ascorbic acid was administered to patients with chronic hepatitis C to elucidate the mechanism of onset of retinopathy during interferon (IFN) therapy, and its prevention.. The subjects were 62 patients with chronic hepatitis C who had been admitted to our hospital. For the IFN therapy, 6 MIU of natural IFN-alpha, or 10 MIU of recombinant human IFN-alpha 2b was administered every day for the first 2 weeks, followed by administration three times a week for 22 weeks. The patients were randomly assigned to a group receiving 600 mg/day of ascorbic acid or a group not receiving ascorbic acid (control group). The optic fundi were examined by ophthalmologists before the IFN therapy began and subsequently at weeks 2 and 4 and then every 4 weeks during the IFN therapy.. Retinopathy was found in 9 of the 31 patients (29%) in the ascorbic acid-treated group and in 11 of the 31 patients (35%) in the control group. The cumulative incidence of hemorrhage in the ascorbic acid-treated group was lower than that in the control group during the IFN therapy, but the difference between the two groups was not significant (P = 0.186). The cumulative incidence of cotton-wool spots in the ascorbic acid-treated group was almost same as that in the control group during the IFN therapy. The median platelet counts before the therapy was begun were 11.8 x 10(4)/mm2 in the group with hemorrhage and 16.6 x 10(4)/mm2 in the group without, and the lowest platelet counts during IFN therapy were 7.3 x 10(4)/mm3 in the group with hemorrhage and 9.5 x 10(4)/mm3 in the group without, indicating significantly lower values in the group with hemorrhage (P = 0.018 and P = 0.020, respectively). The lowest platelet counts during IFN therapy were 7.4 x 10(4)/mm3 in the group with cotton-wool spots and 9.7 x 10(4)/mm3 in the group without, indicating a significantly lower value in the group with cotton-wool spots (P = 0.036).. Ascorbic acid was not considered to be useful for the prevention of the retinopathy associated with IFN therapy in patients with chronic hepatitis C.

Topics: Adult; Aged; Antioxidants; Antiviral Agents; Ascorbic Acid; Female; Hepatitis C, Chronic; Humans; Interferon-alpha; Male; Middle Aged; Retinal Degeneration; Treatment Outcome

An imbalance between oxidative stress and antioxidative defence mediates a variety of diseases pathogenesis. The present study aims to assess the possible outcome of supplementation of oral vitamin-C (VC), an antioxidant, in Viral Hepatitis C (HCV) treatment as an adjuvant therapy. 200 HCV-patients were selected, 100 were given Vitamin-C (1000 mg/day) along with anti HCV treatment (sofosbuvir plus daclatasvir) while the other 100 took only anti-HCV treatment for 4weeks. The serum ascorbic acid (Vitamin-C) levels and functions of the liver were tested before and after the VC supplementation. HCV patients with relatively low serum ascorbic acid showed significant improvement after the intake of vitamin C. After 4 weeks of treatment, AST, ALP, albumin, and total, direct and indirect bilirubin were improved significantly in the VC group; whereas only ALT and indirect bilirubin were improved in both groups when associated with the control subjects. Comparing the two treatment groups at 4weeks; more effective and significant improvement was observed in ALT (p<0.01), AST (p<0.001), direct (p<0.01) and indirect bilirubin (p<0.001), total proteins (p<0.001) and albumin (p<0.05) in patients with VC supplementation on anti-viral treatment compared to only anti-viral treatment group. Thus, VC supplementation improves the antiviral therapy outcome by bestowing a beneficial effect in minimizing liver damage in HCV cases.

Topics: Albumins; Antioxidants; Antiviral Agents; Ascorbic Acid; Bilirubin; Dietary Supplements; Drug Therapy, Combination; Hepacivirus; Hepatitis C; Hepatitis C, Chronic; Humans; Treatment Outcome; Vitamins

Generalized essential telangiectasia, which is a rare condition that is characterized by the progressive development of telangiectases on the skin, is a clinical diagnosis of exclusion. We present a 65-year-old man with a ten-month history of an asymptomatic eruption of the trunk and proximal aspects of the arms and hands that was comprised of macules and patches of telangiectases. The clinical presentation, associated diseases, hypotheses regarding pathogenesis, differential diagnoses, and reports on treatment modalities are reviewed. The relatively new association of this entity with systemic signs that include hemorrhage as well as the occurrence of generalized essential telangiectasia in patients with a history of hepatitis is discussed.

Topics: Aged; Alanine Transaminase; Ascorbic Acid; Aspartate Aminotransferases; Hepatitis C, Chronic; Humans; Liver Cirrhosis; Male; Platelet Count; Telangiectasis; Ultrasonography

Eicosapentaenoic acid (EPA) (1.8 g/day) was administered to 12 chronic hepatitis C patients receiving combination therapy of pegylated interferon (PEG-IFN) alpha-2b and ribavirin for 48 weeks (EPA group). Twelve patients were not administered EPA (control group). All patients also received vitamin E and C (300, 600 mg/day, respectively) during the therapy. Serum alanine aminotransferase improved to a normal level in 8 of 12 patients from the EPA group and 6 of 12 patients from the control group after 12 weeks. Lymphocyte counts decreased significantly after 8 weeks in the control group, but not the EPA group. T-helper (Th) 1 decreased after 4 weeks in the control group, but not in the EPA group (two-way ANOVA; P < 0.05). Th1/Th2 ratios were elevated in 9 of 12 patients in the EPA group, and 3 out of 12 in the control group (P < 0.05) after 8 weeks. After 12 weeks, the arachidonic acid/EPA molar ratio of erythrocyte membrane phospholipid correlated negatively with the leukocyte count (n = 24, r = -0.439, P < 0.05) and the neutrophil count (n = 24, r = -0.671, P < 0.02). The hemoglobin level improved after 48 weeks compared with 24 weeks in only the EPA group. These findings suggest that EPA supplementation may be useful in therapy for chronic hepatitis C.

Topics: Alanine Transaminase; Antiviral Agents; Ascorbic Acid; Dietary Supplements; Drug Therapy, Combination; Eicosapentaenoic Acid; Female; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Polyethylene Glycols; Recombinant Proteins; Ribavirin; Vitamin E

This study addressed the suggested association between levels of the antioxidants glutathione (GSH), vitamin C and vitamin E in peripheral blood and the histological activity and fibrosis stage in chronic hepatitis C (CHC). We then determined whether regular antioxidant supplementation influenced these antioxidant levels or disease severity.. Clinical, biochemical, histological and demographic data were collected from 247 CHC patients at the time of liver biopsy. Whole blood total GSH, plasma vitamin C and E were assessed by high-performance liquid chromatography. Statistical analyses were performed to test for associations between the variables and to identify independent predictors for hepatic necroinflammatory and fibrosis scores.. GSH and vitamin C, but not vitamin E correlated with both portal/periportal activity (r = -0.19, P = 0.004; r = -0.19, P = 0.009 respectively) and fibrosis stage (r = -0.18, P = 0.007; r = -0.18, P = 0.009 respectively). GSH was an independent negative predictor of portal/periportal inflammation (P = 0.02) and fibrosis (P = 0.01). Vitamin C was an independent negative predictor of fibrosis stage (P = 0.02). Antioxidant intake was associated with higher vitamin C (P < 0.0001) and vitamin E (P = 0.005) levels, but not GSH.. Whole blood GSH and plasma vitamin C are negatively associated with hepatic portal/periportal inflammation and fibrosis stage in CHC. Controlled intervention studies with vitamin C and agents that boost endogenous GSH levels are warranted.

Topics: Adolescent; Adult; Aged; Antioxidants; Ascorbic Acid; Biomarkers; Biopsy; Cohort Studies; Dietary Supplements; Female; Glutathione; Hepatitis C, Chronic; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Severity of Illness Index; Viral Load; Vitamin E

The pathogenesis of chronic hepatitis C (HCV) infection is not fully known, but oxidative stress may play a role. The aim of this study was to assess the relationship between HCV load and antioxidant status among patients with chronic HCV infection. Among 23 patients, HCV load, as well as plasma beta-carotene, retinol, ascorbic acid and alpha-tocopherol were measured. Plasma retinol, ascorbic acid and alpha-tocopherol were low in 17%, 26% and 4% of the patients, respectively. Plasma ascorbic acid and alpha-tocopherol declined 9.7 micromol/l (95% CI 3.3-16.2) and 4.5 micromol/l (95% CI 2.1-7.0), respectively, and plasma beta-carotene declined by a factor of 0.60 (95% CI 0.37-0.98) per log increase in viral load. Smoking was independently associated with 8.9 micromol/l (95% CI 4.1-13.7), lower levels of plasma alpha-tocopherol and with 0.27 (95% CI 0.11-0.71) times lower plasma beta-carotene. The effect on plasma ascorbic acid was not significant (-9.2 micromol/l, 95% CI - 21.9-3.5). The association may reflect consumption of antioxidants due to HCV, although effects of low antioxidant status on viral replication cannot be excluded.

Topics: Adult; alpha-Tocopherol; Antioxidants; Ascorbic Acid; beta Carotene; Female; Hepacivirus; Hepatitis C, Chronic; Humans; Male; Middle Aged; Oxidative Stress; Viral Load

Herbal therapies are used by a substantial proportion of persons in the United States, and use of these supplements may be even higher in those with chronic liver disease. The aims of this study were to prospectively determine the proportion of US veterans with chronic hepatitis C that are currently taking vitamins and herbal medications and to evaluate factors associated with use of herbal preparations.. Patients with hepatitis C who were seen in the gastroenterology, infectious disease, and primary care clinics at the VA New York Harbor Healthcare System were invited to participate in this prospective study. For comparison, healthy patients without hepatitis C were enrolled from the primary care clinics at the same medical center. Patients were interviewed by trained research coordinators who obtained detailed demographic and clinical data, as well as information on the use of antioxidants (vitamin C and E), multivitamins, and herbal medications.. Use of vitamin C (34.8% vs. 19.6%, P < 0.001), vitamin E (25.8% vs. 13.2%, P < 0.001), multivitamins (43.6% vs. 28.0%, P < 0.001), and herbal therapies (21.0% vs. 10.4%, P < 0.001) was significantly higher in the 500 patients with hepatitis C compared with the 250 healthy controls. The most common herbal medications taken by hepatitis C patients were milk thistle (12.2%), ginseng (4.6%), and echinacea (3.0%). After adjusting for age and gender, multivariate logistic regression identified 12 or more years of education (OR 2.7; 95% CI 1.6-4.3; P < 0.001) and annual income of at least 20,000 US dollars (OR 2.0; 95% CI 1.3-3.2; P = 0.004) as the only significant predictors of herbal medication use in patients with hepatitis C.. The use of herbal preparations is prevalent among veterans with chronic hepatitis C, especially those with higher levels of education and higher incomes. Obtaining a detailed medical history and documentation of the use of these supplements is critical to determine the potential for herbal-drug interactions and hepatotoxicity.

Topics: Adult; Antioxidants; Ascorbic Acid; Echinacea; Female; Hepatitis C, Chronic; Humans; Logistic Models; Male; Middle Aged; Panax; Phytotherapy; Plant Preparations; Prevalence; Silybum marianum; United States; Veterans

Chronic hepatitis C infection is a major world-wide problem, frequently progressing to cirrhosis, liver failure or hepatoma. The pathological mechanisms of disease progression are unclear but oxidant stress may play a role.. Markers of lipid peroxidation, antioxidant status, hepatic fibrogenesis and liver function were measured in blood or urine from 42 chronic hepatitis C patients. Fibrosis was graded histologically in a subgroup of 33 patients.. The lipid peroxidation marker 8-isoprostane and the ratio of oxidized to reduced glutathione were significantly elevated (P<0.001, P=0.006). The antioxidants glutathione, selenium and vitamins A, C and E were significantly decreased (all P<0.001) compared to age and sex matched controls. Abnormal values were more marked in cirrhotics, but significant changes were also observed in the non-cirrhotic group. The fibrosis score correlated positively with urinary 8-isoprostane and type III procollagen peptide and negatively with vitamin A.. Oxidant stress, as reflected in blood and urine by a wide range of pro- and antioxidant markers, is a significant feature of hepatitis C infection. Although more severe in the cirrhotic group, there was clear evidence of oxidant stress in non-cirrhotic patients. Antioxidant therapy may therefore have a role in slowing disease progression to cirrhosis.

Topics: Adult; Aged; Antioxidants; Ascorbic Acid; Dinoprost; F2-Isoprostanes; Female; Glutathione; Hepatitis C, Chronic; Humans; Lipid Peroxidation; Liver Cirrhosis; Male; Middle Aged; Oxidative Stress; Selenium; Vitamin A; Vitamin E

A new antiviral and immunomodulating preparation Viferon, produced as rectal suppositories containing recombinant alpha-2b-interferon (IFN) and antioxidants, was used in complex therapy of viral chronic hepatitides B and C (ChHB and ChHC) in children. Results of our investigation showed a high efficiency of Viferon. Viferon was found to suppress replication of hepatotropic viruses and to decrease activity of the pathologic process in the liver of children with ChHB and ChHC. After a Viferon treatment with daily doses of (1-2) x 10(6) IU of IFN (3.0 x 10(6) IU/m2) primary remission was registered in 78% of patients with ChHB and in 44% of patients with ChHC, while lasting remission was found in 82% of ChHB and in 33% of ChHC patients. Thus, a more marked effect was observed with ChHB, in which 3.0 x 10(6) IU/m2 was the optimal daily dose for children. Increasing the dose to 5.0 x 10(6) IU/m2 did not result in rise of the percentage of the remissions. Side effects, which are characteristic for injection of IFN preparations, were never found even after a longterm treatment. Absence of induction of neutralizing antibodies was observed after administration of alpha-2b-IFN, an integral part of Viferon. In pediatrics, the method of rectal administration has advantages over parenteral delivery due to its convenience, non-traumatic character and possibility of use for prolonged periods.

Topics: Adolescent; Antioxidants; Antiviral Agents; Ascorbic Acid; B-Lymphocytes; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Therapy, Combination; Hepatitis B, Chronic; Hepatitis C, Chronic; Humans; Infant; Interferon alpha-2; Interferon-alpha; Recombinant Proteins; Suppositories; T-Lymphocytes; Treatment Outcome; Vitamin E