الفهرس 
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Abstract
According to the report of world health organization (WHO), Egypt has the highest prevalence of the Hepatitis C virus (HCV) in the world.
The standard of care for treatment of HCV infection was combination therapy with pegylated-interferon (PEG-IFN) plus ribavirin (RBV).
Anemia during combination therapy of HCV is considered a serious side effect and often necessitates dose reduction and premature withdrawal of therapy. This may be primarily caused by a ribavirin-induced hemolysis and secondarily by interferon-induced bone marrow suppression.
These side-effects of treatment may lead physicians for dose modifications or in some cases termination of therapy, eventually this issue may affect the final goal of HCV treatment, which is the eradication of infection.
RBV can be incorporated into erythrocytes, where it undergoes phosphorylation to its active forms RBV triphosphate (RBV-TP). RBV triphosphate accumulate intracellulary causing depletion of adenosine tri-phosphate (ATP) in RBCs, oxidative damage and leading to hemolysis.
The ITPA gene, located on chromosome 20, encodes the enzyme ITPase which catalyses the conversion of inosine triphosphate (ITP) to inosine monophosphate and pyrophosphate so that ITP does not accumulate in normal cells.
So, ITPase deficiency or low activity causes the accumulation of ITP in the red blood cells (RBCs).