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Anemia and Hepatitis C Treatment

January 24, 2012

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In opposition to what seems logical, research demonstrates that becoming anemic while on Hepatitis C therapy is not such a bad thing.

by Nicole Cutler, L.Ac.

Hepatitis C treatment rests on the medications pegylated interferon and ribavirin, a combo known to cause anemia. Side effects from this traditional Hepatitis C-fighting duo are often blamed for patients discontinuing therapy and thus being unsuccessful in eliminating the virus from their body. However, researchers claim that anemia, one of the most common Hepatitis C drug side effects, may actually be a good indication that treatment will be successful.

Up until recently, standard therapy for this virus only consisted of pegylated interferon and ribavirin - a combination that was about 50 percent effective in people with the most common Hepatitis C strain: genotype 1. Although likely to dramatically boost the Hepatitis C cure rate, the latest addition of two new drugs to the Hepatitis C arsenal have not been available long enough to reliably quote how effective they are. Nonetheless, the new drugs (Incivek or Victrelis) still must be given in conjunction with pegylated interferon and ribavirin. Thus, anemia from Hepatitis C treatment remains a prominent concern.

About Anemia
Anemia develops from abnormally low levels of red blood cells or hemoglobin. Severe anemia means that a person's blood cannot carry enough oxygen to meet the needs of the body's tissues. Although other substances in the body carry oxygen to the body's tissues, hemoglobin can carry four times as much oxygen throughout the body than water or plasma.

The normal, average life span of a red blood cell is 90 to 120 days. After red blood cells have worn out, the spleen removes them from circulation. To replace those that have been removed, new red blood cells are produced in the bone marrow. Having a healthy amount of oxygen-carrying hemoglobin is a balancing act between making new red blood cells and replacing destroyed red blood cells. When this balance is thrown off kilter, a person can develop anemia.

Anemia from Hepatitis C Drugs
At least 20 percent of people treated with pegylated interferon and ribavirin get drug-induced anemia. The reason is twofold:

1. Ribavirin causes a dosage-dependent, hemolytic anemia, where red blood cells are destroyed faster than the body can make enough new ones to replace them.

2. Interferon can exacerbate anemia by suppressing the bone marrow's production of new red blood cells.

Anemia is one of the most clinically significant side effects of Hepatitis C therapy. Symptoms of anemia include:

• Shortness of breath
• Fatigue
• Pale skin color
• Chills
• Rapid heart rate
• Depression
• Reduced quality of life

If not carefully monitored and treated, hemolytic anemia can lead to jaundice, dark urine, an enlarged spleen and, in severe cases, a heart attack. Because this side effect can be severe, there is a regime for handling anemia while on Hepatitis C treatment. In general, the first approach is to reduce ribavirin dosage. If that is insufficient, an erythropoiesis-stimulating agent (ESA) like Procrit or Epogen is given to boost red blood cell production.

Anemia Is a Good Thing
Between the fear of becoming anemic on treatment, experiencing its discomfort or being skeptical of reducing ribavirin dosage or adding another drug to their regimen, most people on Hepatitis C drugs don't welcome anemia. However, data published in the November 2010 issue of the journal Gastroenterology ought to change that sentiment. According to researchers, Hepatitis C patients who develop anemia during treatment with pegylated interferon plus ribavirin are more likely to achieve a sustained virological response - the elimination of the virus from their body - than those who don't become anemic on the drugs.

Upon analyzing over 3,000 people being treated for Hepatitis C with pegylated interferon and ribavirin, Mark Sulkowski and colleagues found this to be true even when ribavirin reduction or ESA administration was given to reduce anemia. In fact, the rates of achieving a sustained virological response were greater as the severity of the anemia increased.

Because the standard duo of Hepatitis C drugs appears to be more effective in patients who incur anemia as a side effect, plummeting hemoglobin levels doesn't seem so dreadful. Especially since reducing ribavirin dosage or taking an ESA doesn't negatively impact treatment success, there is even more motivation to go on these drugs, be carefully monitored by a physician and complete the prescribed Hepatitis C drug treatment regimen.

References:

http://www.gastrojournal.org/article/S0016-5085%2810%2901222-9/abstract,
Hepatitis C Virus Treatment-Related Anemia Is Associated With Higher Sustained Virologic Response Rate, Mark S. Sulkowski, et al, Retrieved August 7, 2011, Gastroenterology, November 2010.

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/SEM_anemia_08.pdf, HCV Treatment Side Effect Management: Hemolytic Anemia, Alan Franciscus, Retrieved August 7, 2011, Hepatitis C Support Project, 2011.

http://www.hepatitis.va.gov/provider/reviews/treatment-side-effects.asp#SanemiaX, Interferon and Ribavirin Treatment Side Effects, Retrieved August 7, 2011, United States Department of Veteran Affairs, 2011.

http://www.hepfi.org/nnac/pdf/hepc_anemia.pdf, Hepatitis C Treatment and Anemia, Retrieved August 7, 2011, Hepatitis Foundation International, 2011.

http://www.hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-side-effects/447-hcv-anemia-neutropenia/568-anemia-during-hepatitis-c-treatment-predicts-sustained-response-to-pegylated-interferonribavirin, Anemia During Hepatitis C Treatment Predicts Sustained Response to Pegylated Interferon/Ribavirin, Liz Highleyman, Retrieved August 7, 2011, hivandhepatitis.com, 2011.

Posted by Editors at January 24, 2012 12:05 PM

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