OBJECTIVETo perform a preliminarily study on the relationship between the duration and dosage of ribavirin treatment and its antiviral effect against chronic hepatitis C.

METHODSA total of 69 patients with chronic hepatitis C whose hemogloblin (HGB) level had decreased to 100 g/L were divided into two groups for receiving a reduced dosage of ribavirin when their HGB level fell to less than or equal to 100 g/L or for withdrawal of the ribavirin treatment when their HGB level fell to less than or equal to 80 g/L (restricted group), or for receiving a reduced dosage when the HGB level fell to less than or equal to 80 g/L or for withdrawal of the ribavirin treatment when the HGB level fell below less than or equal to 60 g/L (adjusted group).The rates of sustained virological response (SVR), relapse, and incidence of adverse effects were statistically compared between the two groups.

RESULTSThe adjusted group had a significantly higher SVR rate than the restricted group (91.17% vs.74.29%, P = 0.049). At the 2-year follow-up after treatment withdrawal, there were significantly less cases of relapse in the adjusted group than in the restricted group (23.07% vs.6.45%, P = 0.038).The adjusted group had lower incidence rates of severe anemia and cardiovascular events but there was no significant difference from these rates in the restricted group (P more than 0.05).Subgroup analysis of the adjusted group showed that the patients with HCV-RNA baseline level of less than 5 lg copy/ml had a significantly higher SVR rate than the patients with HCV-RNA baseline level of more than 5 lg copy/ml (100% vs.76.92%, P = 0.021), and that the patients infected with non genotype-1 had a significantly higher SVR rate than patients infected with genotype-1 (100% vs.70.00%, P = 0.005).

CONCLUSIONWhen patients with chronic hepatitis C develop anemia during the course of anti-HCV ribavirin therapy with Peg-IFNat2a, adjustment of the ribavirin treatment duration and dosage can increase the likelihood of achieving and sustaining SVR and decrease the rate of relapse; these treatment adjustments are not associated with changes in severe adverse effects.The adjustment approach, however, shows more benefit for patients with lower viral load and non genotype-1 infection.