Bani-Sadr et al identified risk factors for anemia in a patient co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Anemia develops in 10-20% of these patients during anti-HCV therapy. The authors are from multiple hospitals in France in the ANRS HCO2 - Ribavic Study Team.


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



• 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.


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