Factors influencing ribavirin-induced hemolysis

Background/Aims: One of the major side effects of the combination therapy for chronic hepatitis C is ribavirin-induced hemolytic anemia. Little is known about variables influencing this anemia. Our study tried to search for these variables in a large group of patients with hepatitis C treated with the combination therapy. Methods: Two hundred and forty-four patients chronically infected with the hepatitis C virus were treated either with induction treatment (daily dose of interferon) or with a standard treatment (interferon thrice weekly). Both groups received 1000–1200 mg of ribavirin from week 4 until the end of the treatment. The drop in hemoglobin level was defined as the difference between the pretreatment hemoglobin level and the hemoglobin level at week 8. Seventeen variables which could possibly influence this drop in hemoglobin level were examined. Results: After multivariate analysis, the drop in hemoglobin level was only significant influenced by pretreatment platelet level, treatment and haptoglobin phenotype. The ribavirin dose did not influence the drop in hemoglobin level or the early virological response. Conclusions: Ribavirin-induced hemolysis is influenced by the pretreatment platelet level, the administered amount of α-interferon and the haptoglobin phenotype. A careful search for the minimal dose of ribavirin needed in combination treatment is necessary.