Anaemia, neutropenia and thrombocytopenia
HIV-positive people with a low CD4 count may have low white and/or red blood cell counts.
Regular monitoring of white and red blood cell during HCV treatment is especially important for people with coinfection, since there is a greater risk for anaemia, neutropenia and thrombocytopenia.
Anaemia
Anaemia (an abnormally low red blood cell count) is a side effect of ribavirin. Interferon can also cause anaemia because it suppresses the growth of bone marrow, where blood cells develop.
The most common symptom of anaemia is fatigue.
Anaemia is a common problem for HIV-positive people, and can be caused by AZT and ribavirin. If possible, use an alternative HIV drug to AZT as combining AZT with ribavirin increases the risk.
Combivir and Trizivir both contain AZT.
There are two ways to treat anaemia from ribavirin. One strategy is to lower the dose of ribavirin, but HCV treatment may not work as well. The other is to treat anaemia with injections of epoetinalpha (EPO), which improves fatigue and helps people to stay on ribavirin.
Severe anaemia is treated by blood transfusions, but reducing the ribavirin dose or starting EPO if anaemia develops during HCV treatment can avoid this.
Neutropenia
Neutropenia is an abnormally low amount of neutrophils, a white blood cell that fights bacterial infections. Interferon can cause neutropenia.
The risk of developing bacterial infections is increased in people with neutropenia. If the neutrophil count drops during HCV treatment, the dose of PEG interferon is reduced, or neutropenia is treated with injections of white cell growth factor called filgrastim (Neupogen).
Thrombocytopenia
Thrombocytopenia is a low platelet count, and can be caused by serious liver damage (because the hormone that stimulates platelet production is made in the liver). It can also be caused by other medical conditions, including HIV itself, and by pegylated interferon.
Thrombocytes or platelets stop bleeding by clotting blood. Serious thrombocytopenia can have life-threatening consequences, such bleeding inside of the brain.
If severe thrombocytopenia develops, HCV treatment is usually stopped.
I’m currently in month four of treatment. The aenemia is better and I’m still hepC negative. I can’t wait to get to month 12 and use the C word – CURE.