Anemia (hemoglobin < 10 g/dL) is relatively common in patients with HCV treated with ribavirin and interferon. The onset of the anemia is usually during the first 3 months of therapy.
Mechanisms for anemia in a patient treated with HCV:
(1) ribavirin-induced hemolysis
(2) interferon-induced bone marrow suppression
Factors increasing the risk of anemia:
(1) pretreatment hemoglobin that is low normal or below normal
(2) therapy with zidovudine (which increases plasma levels of ribavirin)
(3) pegylated interferon alpha (peg-IFN), compared to non-pegylated IFN
where:
• Hemoglobin ranges were not analyzed differently for men or women.
• The mean hemoglobin value for the anemia group was 13.1 +/- 1.4 g/dL. For the implementation a hemoglobin < 13.1 will be used as a risk factor.
Factors reducing the risk of anemia:
(1) therapy with protease inhibitor
Management options:
(1) If receiving HIV therapy, discontinue zidovudine (if being used) and start a protease inhibitor-based regimen.
(2) Monitor the patient for anemia, especially if pretreatment hemoglobin is low.
