Impact of Direct Acting Antiviral (DAA) Agents on hematological and hepatic statuses of patients with chronic hemolytic anemias and chronically infected with hepatitis C virus (HCV)

Abstract

Hepatitis C virus (HCV) infection is a global epidemic. According to the World Health Organization (WHO), approximately 71 million people are currently living with hepatitis C virus worldwide, which is the main cause of chronic hepatitis. Patients with hepatitis C share a variety of anemias, including the so‐called ‘anemia of chronic disease,’ bleeding, and nutritional deficiencies – similar to patients with other chronic diseases. Current treatment for chronic hepatitis C virus (HCV) infection is combination therapy with pegylated interferon (peginterferon) plus ribavirin. Hemoglobin concentrations decrease mainly as a result of ribavirin‐induced hemolysis, and this anemia can be problematic in patients with HCV infection, especially those who have comorbid renal or cardiovascular disorders. In general, anemia can increase the risk of morbidity and mortality, and may have negative effects on cerebral function and quality of life. Although ribavirin‐associated anemia can be reversed by dose reduction or discontinuation, this approach compromises outcomes by significantly decreasing SVR rates. Recombinant human erythropoietin has been used to manage ribavirin‐associated anemia but has other potential disadvantages.