Ribavirin Induced Anemia among Patients with Hepatitis-C at Tertiary Care Hospital.

Abstract

Introduction: Hepatitis C is among one of the major global health issues; which may cause chronic liver disease, end stage liver disease, and hepatocellular carcinoma; subsequently requiring liver transplant. For HCV, standard treatment is a combination therapy of ribavirin and interferon for six months. Ribavirin fostered hemolysis is a major treatment-associated adverse effect.Objective: To assess ribavirin induced anemia among Hepatitis C patients visiting Civil Hospital, Karachi (CHK).Methodology: This hospital-based cross-sectional study was conducted from October 2017 to January 2018. 106 Hepatitis C patients; through non-probability convenient sampling technique; visiting CHK, a public sector tertiary care hospital were enrolled. Results: Among106 patients, 53 (50.0%) were males and 53 (50.0%) were females. Mean ±SD age was 37.05 ±10.793. Mean ±SD duration of ribavirin use was 3.03 ±1.523 months. Around 16.0% had ribavirin dose reduction. All of them experienced weakness, fatigue and light-headedness, 59.4% developed microcytic hypochromic anemia, 23.6% had severe anemia. Mean ±SD hemoglobin (g/dL) level before the onset of treatment was 12.78 ±1.555. Mean hemoglobin level during treatment was 10.72g/dL. Mean reduction in hemoglobin levels was 2.07g/dL. The reduction in hemoglobin levels and the duration of therapy were correlated (p-value <0.05). The severity of anemia was related to age of the patients (p-value <0.05) but not with gender and morphology of red blood cell.Conclusion: Ribavirin induces anemia, its severity is related to the duration of ribavirin therapy and initial hemoglobin levels. It is sometime severe enough to warrant dose reduction and consequently suboptimal dose of ribavirin affect efficacy.
 Key Words: Hepatitis C, Ribavirin, Microcytic Hypochromic Anemia.