Hepatitis C Management

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Question:

I have a 44-year-old female patient recently diagnosed with HCV, genotype 1a. Her viral load is 176,000 copies per mL but she has no symptoms. She has a history of sickle cell-thalassemia and has received many blood transfusions. Currently, she is being treated with hydroxyurea and is maintaining a hemoglobin of 8.5 to 9.9 g/dL. Considering that interferon and ribavirin will lower hemoglobin, is treatment with those drugs advisable? Is viramidine a treatment option?
 
There are two issues with patients having sickle-cell anemia. First, interferon can cause dehydration, which can precipitate a sickle crisis. Additionally, moderate to severe anemia can predispose these patients to ribavirin-induced hemolytic anemia. Although viramidine (Taribavirin) may have lower rates of treatment-induced anemia, its efficacy has not been fully established. I suggest that a liver biopsy be considered. If the patient has mild liver disease, I do not recommend treatment with currently available anti-HCV therapy.

For more information, see the section on liver biopsy in the Hepatitis C Management monograph.

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