Document resource
Background Sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV) is the current treatment regimen for hepatitis C (HCV) cirrhosis patients in Thailand. Several studies showed that ribavirin can induce anemia, leading to blood transfusions and potentially compromising treatment outcomes. Our study was therefore designed to systematically determine the prevalence and clinical predictors of ribavirin-induced anemia (RIA) and evaluate its impact on treatment outcomes in this population.Methods This retrospective study was conducted at a tertiary hospital in Thailand. All patients over 18 years with HCV cirrhosis treated with SOF/VEL/RBV between January 2021 and October 2025 were included. Patients with concomitant hematologic diseases, renal failure, malignancy, or other anemia causes were excluded. We collected data with a focus on RIA prevalence, the need for treatment modification, and sustained virological response at 12 weeks (SVR12).Results 76 patients were included. 61.8% were male, with a median age of 58. 85.5% had a Child-Pugh score of A. The prevalence of RIA, defined as new-onset anemia after RBV initiation, was high at 61.8%. Hemoglobin (Hb) level in the RIA group was significantly lower than the non-RIA group at the 12th week of treatment (p=0.039). However, on the 12th week post-treatment, Hb levels were comparable (p=0.827). In the RIA group, almost one-half (46.8%) developed at least a moderate degree of anemia, 12.8% had severe to life-threatening anemia, over one-fifth (21.3%) needed blood transfusions, and 4.3% needed RBV dose reductions. Of note, RBV was halted in 2.1% of the RIA group. Surprisingly, multivariable logistic regression analysis demonstrated that patients who had pre-existing anemia by World Health Organization (WHO) definition were independently protected against developing progressive anemia during RBV treatment (OR 0.19, 95%CI 0.06-0.65; p=0.008). Nevertheless, the rates of SVR12 post-treatment were comparable between the 2 groups (p=0.555).Conclusions In cirrhotic HCV patients, RIA is common, with a prevalence of over 60%, and necessitates intervention. However, this effect vanished at post-treatment 12 weeks. Importantly, the presence of pre-treatment anemia was inversely associated with progressive anemia during RBV therapy. The comparable SVR12 rates suggested that RIA, when managed, didn’t compromise virologic response. This finding supports the continued use of RBV in this high-risk population.