Infection with the hepatitis C virus (HCV) remains chronic in 75% of infected individuals, in whom it can cause liver inflammation and progressive fibrosis leading to cirrhosis in 20% of patients.

A sustained viral response (SVR) to HCV therapy, i.e. undetectable plasma HCV RNA 6 months after the end of treatment, leads to permanent eradication of the virus in 98.3% of patients.

The current treatment of choice is combination therapy with pegylated interferon alfa (PEG-IFN alfa), 2a or 2b, and ribavirin (RBV), which achieves an SVR in 54-56% of patients.

In patients with HCV genotype 1, RBV doses of 1000-1200 mg/day are associated with a higher SVR than 800 mg/day (51 vs 40%).

However, RBV also causes dose-dependent reversible hemolytic anemia that, in combination with the myelosuppressive effects of PEG-IFN, results in a mean drop in hemoglobin (Hb) level of 3.7 g/dL within 4 weeks.

Conventionally, this acute anemia has been managed with RBV dose reductions. However, this may result in a decreased SVR rate.

Alternatively, this anemia can be managed with administration of epoetin alfa (Procrit) at 40 000 IU once weekly.

In a randomized placebo-controlled trial, treatment with epoetin alfa has been shown to raise Hb levels and maintain RBV doses.

Furthermore, the increase in Hb level was associated with improved quality of life.

In conclusion, the authors write, “Anemia in patients treated with interferon plus RBV combination therapy can be managed effectively and safely with once weekly epoetin alfa without sacrificing optimal dosing of RBV.”

Department of Medicine, Division of Infectious Diseases, Veterans Affairs Medical Center, Bronx, and Mount Sinai School of Medicine, New York, NY, USA. norbert.brau@med.va.gov

N Brau. Epoetin alfa treatment for acute anemia during interferon plus ribavirin combination therapy for chronic hepatitis C. Journal of Viral Hepatitis 11(3): 191-197. May 2004.

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