Q: I was declared HCV positive and underwent Pegasys + Ribazole 400x3 for ten weeks. I had to abandon it because of a flash drop in haemoglobin (Hb), which dropped to 5.2. On doctor's advice, I restarted 24 injections, weekly course, with 2x400 Ribazole. I managed 17 injections at a stretch with random help of Erythropoeitin but developed dark constipated stool and the Hb dropped from 11 to 4.5. An endoscopy was carried out and 5 bands applied in the oesophagus. My present Hb is 8 and I underwent blood transfusion. My latest quantitative PCR is negative for the past 3 weeks ever since the discontinuation of Pegasys. What should be my next move? Should I wait to see if RNA continues to remain negative or should I complete the 7 injections after my Hb touches 13 as recommended by my doctor here? My ultrasound says mild coarse appearance of live and portal vein 12 and spleen 13.5; GENO TYPE 3-a.

A:Pegasys is the brand name of a medicine called peginterferon alfa-2a. Ribazole contains ribavirin. In the treatment of Hepatitis C, peginterferon alfa-2a is indicated when HCV-RNA is positive i.e. there is active viral load. It can be used alone or in combination with ribavirin. However ribavirin is not to be used alone. The most common side effect of ribavirin is anaemia and haemolysis (destruction of red blood corpuscles). Your anaemia could be either due to ribavirin or bleeding from the food pipe (independent of ribavirin). The side effect on blood of Pegasys is lowering of white cells and platelets. The lowering of platelets can lead to bleeding. You have not given the platelet count; hence it is not possible to say whether the bleeding in your food pipe is due to adverse effect of Pegasys on platelets or not. Hepatitis C can be genotype-1 or genotype-2/3. In genotype 1, the initial treatment should last for 48 weeks; in genotype-2/3, it is to be given for 24 weeks only. Once this period is over, the blood needs to be tested for viral activity and determine whether treatment is benefiting the patient. If the patient is benefiting, then it can be continued for up to one year if required. Depending on the cause of anaemia (due to Pegasys leading to low platelets leading to blood loss leading to anaemia or due to side effect of ribavirin), a decision has to be taken. However ribavirin can not be given alone. Hence the option is to give Pegasys alone and see its effect. Also your health provider may wish to wait since now you are HCV-RNA negative. While results of Pegasys + ribavirin are better, Pegasys alone also gives reasonably good results.