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Thoughts on SAMe
Jul 8, 2008

Hi Dr. McGovern: Any thoughts on S-adenosyl methionine or SAMe in patient's with HIV / Hepatitis C. I failed Pegasys/ribavirin therapy and am exploring options to delay hepatic damage while awaiting the next generation of treatments. If not SAMe, would you have other recommendations? (of course I'm not drinking and am adherent to my antiretroviral regimen) Thanks in advance for your response.

Response from Dr. McGovern

I have pasted a link for you if you want additional information on SAM. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1a.section.2295

On this page you will see an official summary of clinical trials which basically says that no conclusions can be made on efficacy of SAM.

My personal advice to you would be to not take anything you don't have to take. I also strongly commend you for avoiding all alcohol.

You may want to review your previous treatment to see if all the conditions for your response were adequate - eg, did you take all your medications with excellent adherence (since this will have a clear effect on outcome). Also did you take weight-based ribavirin (assuming you may have genotype 1 infection). Do you have insulin resistance from being overweight? (eg high fasting insulin levels). This can correlate with poorer outcomes. If so, weight loss may help to restore normal insulin responsiveness.

Yes, new drugs are being developed. Right now there are two protease inhibitors in advanced stages of development - boceprevir and telaprevir. ALso some polymerase inhibitors - eg, R1626 and others. Additional classes are also being explored.

It is an exciting time - but I am sure you are tired of waiting for the promise of these new drugs. Hang in there!



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