The goal of HCV infection therapy is to slow or halt progression of fibrosis and prevent the development of advanced cirrhosis (Wilkins 2010).
Standard treatment for hepatitis C centers upon pegylated interferon plus ribavirin (PEG-IFN/RBV).
- Interferons occur naturally and help the immune system recognize and attack viruses. Pegylated interferon is a chemically altered interferon that remains active in the body for a long time and helps mount robust immunity against HCV.
- Ribavirin is an antiviral drug that interferes with viral replication.
- The combination of the two drugs is more effective than either alone.
During pegylated interferon plus ribavirin treatment, physicians routinely test levels of liver enzymes, HCV antibodies, and the virus itself in the bloodstream. Monitoring these levels can help measure the effectiveness of treatment and determine prognosis (Fort 2012; Munir 2010; Wilkins 2010).
This combination treatment is ineffective in over 40% of HCV patients, leaving these individuals to seek additional approaches to eradicate the virus and/or protect against its damaging effects. Moreover, the contraindications and severe side-effects associated with interferon (e.g., depression, anemia, leukopenia and sepsis) can make treatment challenging (Wilkins 2010; Alkhouri 2012).
Sustained virologic response is the surrogate marker to evaluate the effectiveness of treatment. If HCV treatment is successful, the patient will achieve a sustained virologic response; this occurs when HCV RNA cannot be detected in serum 24 weeks after treatment ends (Alkhouri 2012).
Protecting Against Ribavirin-induced Anemia with Antioxidants
Ribavirin (RBV) can damage red blood cell membranes and cause anemia (Russmann 2006; Hino 2006). This can negatively impact treatment response by necessitating a dose reduction, or force the patient to stop treatment altogether (Krishnan 2011; Reddy 2007).
Oxidative stress contributes to ribavirin-induced breakdown of red blood cell membranes (Russmann 2006), so therapies that aim to quench reactive free radicals have piqued the interest of researchers.
Antioxidants tested on patients with ribavirin-induced anemia have yielded promising results (Thevenot 2006). In chronic HCV patients, 100 grams daily of tomato-based functional food (containing high levels of natural antioxidants) in addition to standard combination treatment decreased the severity of ribavirin-related anemia and increased patient tolerance to the full dose of ribavirin. Specifically, 8.7% of the functional food group had to decrease their daily dose of ribavirin versus 30.4% in the control group (Morisco 2004).
In another study of chronic HCV patients, adding a high daily dose of vitamins C (2,000 mg/day) and E (2,000 mg/day) to combination interferon alfa-2b/ribavirin treatment prevented ribavirin-induced anemia (Kawaguchi 2007). In yet another study, while vitamins C (750 mg/day) and E (500 mg/day) in addition to standard treatment for 26 weeks did not suppress ribavirin-induced anemia, the prevalence of dose reduction was much lower in the vitamin group (14.3%) versus the control group (47.1%). Additionally, only 7.1% of the vitamin group discontinued treatment compared to 35.3% of the control group (Hino 2006).