New Study: A Place for Milk Thistle in Hepatitis C Treatment

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Ever since the newer, direct-acting antiviral drugs were FDA-approved in the Spring of 2011, triple therapy has significantly improved the odds of successfully eliminating the Hepatitis C virus. Despite this therapeutic improvement, individuals co-infected with HIV (the virus that causes AIDS) and Hepatitis C are among the most likely to fail treatment. Researchers in Switzerland have found that administering a potent form of milk thistle prior to beginning triple therapy dramatically improves patient outcome.

HIV/Hepatitis C Co-Infection

According to the U.S. Department of Disease Control and Prevention, approximately one quarter of HIV-infected persons in the United States are also infected with Hepatitis C. Both viruses are transmitted via blood-to-blood contact; thus, simultaneous infection with Hepatitis C and HIV is especially common (50 to 90 percent) among HIV-infected drug users.

Unfortunately, Hepatitis C infection frequently leads to rapid progression of liver disease when paired with HIV infection. Hepatitis C treatment in those who are co-infected with Hepatitis C and HIV is complicated by the hepatotoxic and myelosuppressive effects of HIV therapy and HIV infection itself. As such, clinicians are always on the look-out for safe ways to improve the treatment outcome for people co-infected with Hepatitis C and HIV.

Switzerland Research

Researchers from Zurich, Switzerland conducted a pilot study to see if injection of a highly purified form of milk thistle could improve the Hepatitis C treatment outcome in the face of HIV/Hepatitis C co-infection. Because they have only a 30 percent chance of achieving a successful outcome during triple therapy, individuals were targeted who:

• Had co-infection of Hepatitis C and HIV
• Had advanced liver fibrosis
• Were previous non-responders to peginterferon and ribavirin treatment

The Swiss researchers evaluated the efficacy of administering silibinin prior to beginning triple therapy in these difficult to treat patients. The regimen during this trial was:

• Intravenous silibinin 20/mg/kg per day for two weeks
• Peginterferon-ribavirin and telaprevir triple therapy for the next 12 weeks
• Peginterferon-ribavirin dual therapy for the remaining 36 weeks

With an astounding 80 percent success rate, the researchers concluded that leading in with silibinin before triple therapy is a highly effective way to increase the probability of Hepatitis C treatment success in difficult to treat HIV/Hepatitis C-coinfected patients with advanced liver fibrosis and previous failure of peginterferon-ribavirin.

Silibinin

Milk thistle seed extract has been used for centuries to protect and strengthen liver cells. Milk thistle has been shown to:

• Strengthen the outer walls of liver cells to better resist injury
• Promote the growth of healthy liver cells
• Fight oxidation – a process that damages liver cells

Milk thistle extract is composed of silymarins, a group of potent antioxidants that are responsible for milk thistle’s therapeutic properties. Of the silymarins, silybin (also referred to as silibinin) has been shown to be the most effective constituent of silymarin for benefitting liver health. The caveat to silibinin (or any other milk thistle preparation) is its poor bioavailability. This is likely the reason that the Swiss study described above used intravenous silibinin over the oral route.

Luckily, those wanting to capitalize on this study’s results don’t need to find a doctor who will inject silibinin prior to starting triple therapy. When in phytosome form, silibinin absorption when taken orally is up to ten times more absorbable than the standard silibinin preparation.

Some with Hepatitis C who are previous non-responders and co-infected with HIV may be ready to try triple therapy for an improved chance of treatment success. Whether co-infected with HIV or not, being committed to two weeks of silibinin therapy (either intravenous or the oral phytosome form) may play a vital role in preparing the liver for a successful attempt at eliminating Hepatitis C.