Autoimmune hemolytic anemia in HCV/HIV coinfected patients during treatment with pegylated alpha-2a interferon plus ribavirin

Abstract

Two cases of autoimmune hemolytic anemia that occurred during the treatment of chronic hepatitis C with pegylated alpha-2a interferon and ribavirin, in HIV coinfected patients, are presented and described. The late occurrence (after six months of therapy) of this severe hemolytic anemia leads to the recommendation that hemoglobin levels should be monitored throughout the treatment period, even among patients who presented stable hemoglobin levels in the preceding months.

Severe autoimmune hemolytic anemia during pegylated interferon plus ribavirin treatment for chronic hepatitis C: a case report

“…In fact, several case reports and reviews were published reflecting the AIHA in relapsing remitting multiple sclerosis or hematological disorders under IFN monotherapy . The mechanism of IFN contributing to hemolytic anemia could be due to direct drug medullary toxicity or autoimmunity induction, for example, the expansion of autoreactive B cells . Although PEG‐IFN was stopped, the Hb level continues to decrease probably due to its long half‐life and a strong immune strike .…”

“…Anemia is an important adverse reaction of the drugs used in CHC patient. The use of RBV has been considered the main drug responsible for anemia cases in hepatitis C treatment . RBV causes a dose‐dependent reversible hemolytic anemia due to its direct toxic effect on red blood cells, or even because myelosuppression resulting from negative feedback on erythropoietin receptors .…”

Autoimmune hemolytic anemia in treatment-naive chronic hepatitis C infection: a case report and review of literature

“…De Franceschi et al hypothesized that the underlying oxidative mechanism of ribavarin promotes immune-mediated hemolysis [11]. Numerous case reports have described DI-IHA in the HCV patient population secondary to antiviral therapy [35][36][37][38][39]. Contrastingly, the link between AIHA and HCV in treatment-naive patients has, to date, only been described in 4 reports worldwide [7][8][9][10].…”