Background: Hepatitis C virus (HCV) infection is associated with chronic inflammation and oxidative damage, with hepatic steatosis being common in genotype 3 cases. Vitamin E, a potent antioxidant protective against oxidative stress-induced liver damage in vitro and in vivo, has beneficial effects on alanine aminotransferase (ALT) and histological outcomes in patients with non-alcoholic steatohepatitis.
Objective: To assess the effect of vitamin E on ALT status in patients with HCV genotype 3.
Material and Method: This randomized, placebo-controlled, double-blind trial was conducted in a single tertiary-care hospital (Rajavithi Hospital, Bangkok) between 2010 and 2011. We included patients with HCV genotype 3 infection, unable to receive or tolerate, or did not respond to standard therapy. Responders were defined as patients exhibiting a decrease in serum ALT of at least 5% below the baseline valueafter 12 weeks of treatment.
Results: Thirty-seven eligible patients were randomly assigned either to receive vitamin E 400 IU twice daily (n = 19) or placebo (n = 18; 1 dropped outearly) for 12 weeks.In all, 11of 19 patients in the vitamin E group (57.8%) and 5 of 17 patients in the placebo group (29.4%) were ALT responders. Among responders,serum ALT levels weregreatly decreased in the
vitamin E group (reducing from 122.6+80.1 IU/L to 68.4+25.3 IU/L, p = 0.016), when compared withthe placebo group (reducing from 89.2+40.6 IU/L to 73.6+30.6 IU/L, p>0.05). Vitamin E treatment was well-tolerated with no serious adverse events in the present study.
Conclusion: Vitamin E treatment decreasedserum ALT levels in patients with HCV genotype 3. Because of its good safety profile, vitamin E may be a worthwhile supportive therapy for patients with HCV, particularly for those who were unable to
achieve viral eradication by standard therapy.

Keywords: Vitamin E, Oxidative stress, Hepatitis C virus, Genotype 3, Alanine aminotransferase