Thiamine Helps Hepatitis Patients in Small Study

Giving the B vitamin thiamine to patients with chronic hepatitis B infection improves signs of the disease, a small preliminary study has found. This could point the way to a cheap and nontoxic way of treating the infection.

By Anne Harding

NEW YORK (Reuters Health) – Giving the B vitamin thiamine to patients with chronic hepatitis B infection improves signs of the disease, a small preliminary study has found. This could point the way to a cheap and nontoxic way of treating the infection.

Hepatitis B virus (HBV) is spread through contact with the blood or body fluids of an infected person. HBV infects the liver, and in severe cases can lead to cirrhosis, liver cancer and liver failure. HBV can be treated with antiviral drugs and interferon, but there is no cure.

Dr. Amy Elizabeth Wallace decided to test thiamine for HBV after a “very bright and aware patient”” observed that his aminotransferase levels rose and fell depending on whether he was taking the vitamin. High levels of aminotransferase enzymes indicate more active infection of the liver. In reviewing his chart, Wallace found a relationship–the patient’s aminotransferase levels fell when he took thiamine.

Wallace and her colleague, Dr. William Brinson Weeks, conducted a trial in this patient and two others with HBV infection to investigate the relationship. All had either failed treatment with interferon or could not tolerate the drug.

“While patients were on thiamine treatment, their aminotransferase levels fell from abnormally high to normal levels; these levels increased when thiamine was subsequently withdrawn,”” Wallace and Weeks write in the March issue of The American Journal of Gastroenterology. And in subsequent liver biopsies after thiamine treatment, HBV DNA was undetectable.

This is the first study to investigate thiamine for treating hepatitis B infection. There are several potential ways that the vitamin might fight the infection, according to Wallace, an assistant professor of psychiatry at Dartmouth Medical School in Hanover, New Hampshire.

For example, thiamine binds to iron and thus reduces the iron load in the liver. Past studies have linked high iron levels in the liver to more severe HBV infection, as well as a worse response to interferon.

“Thiamine is so cheap, way cheaper than any of the treatments that are on the market,”” Wallace said. And, she noted, the vitamin has no side effects.

However, more research is clearly needed to determine if thiamine does indeed help patients with HBV, Dr. Raymond S. Koff, a professor in the division of digestive diseases and nutrition at the University of Massachusetts Medical School in Worcester, told Reuters Health.

“The very small number of patients studied is a major limitation of this study,”” he said. “There is no information about thiamine levels before, during or after treatment. A prospective, randomized controlled trial in previously interferon-untreated patients or in nonresponders to interferon therapy will be needed to determine the utility of thiamine in the treatment of chronic hepatitis B.””

SOURCE: The American Journal of Gastroenterology 2001;96:864-868.

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