Hepatitis Web Study

Hepatitis C Treatment: Complications (Anemia)

Authors: John D. Scott , MD

Last updated: December 8, 2005

A 49-year-old Native American man with chronic hepatitis C virus infection, genotype 1a HCV, and compensated cirrhosis starts treatment with peginterferon (Pegasys) and ribavirin (Copegus). His early treatment course is complicated by thrombocytopenia (baseline platelet count of 120,000/mm3 decreases to 50-60,000/mm3), depression, and anemia. His baseline hematocrit and hemoglobin were 42% and 14 g/dL, respectively; after four weeks they are 33% and 11 g/dL. At 12 weeks, the hematocrit is 28% and hemoglobin 9 g/dL. He complains of extreme fatigue, but no syncope. He denies hematemesis or melena. His 12 week HCV RNA level is undetectable. He weighs 175 lbs (80 kg).

Which of the following statements is TRUE regarding anemia in patients taking peginterferon and ribavirin?

A Anemia occurs more frequently with peginterferon than with standard (non-pegylated) interferon.
B Although many patients receiving peginterferon plus ribavirin develop mild anemia, significant anemia (hemoglobin less than 11 g/dL) is uncommon, occurring in less than 5% of those patients who develop anemia.
C Administering epoetin alfa (Epogen™, Procrit™) can increase the hemoglobin level, improve quality of life, and allow for maintenance of higher mean doses of ribavirin.
D Reducing this patient's ribavirin to 600 mg/d will likely completely alleviate his anemia and will not impact the success of antiviral therapy.