الفهرس 
Natural history of chronic hepatitis COnly 14 pages are availabe for public view
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Abstract
Pegylated interferon plus ribavirin therapy given for 48 weeks is
established as the standard therapy for patients with chronic HCV
infection genotype 4 (AlAshgar et al, 2009) .
Forty-eight weeks of combination therapy in genotype 4 patients
showed response rates at an intermediate level compared to genotypes 2
and 3 (Kamal and Nasser, 2008).
Ribavirin has been shown to increase the initial viral kinetic
response to interferon, thus potentially improving early virological
response and overall efficacy of the treatment for hepatitis C (Herrman et
al, 2003).
Ribavirin induces a dose-dependent hemolytic anemia which is
reversible within 4-8 weeks of drug discontinuation. (Sulkowski et al,
2004).
Anemia-related dose reduction or discontinuance may adversely
affect outcome since it reduces the probability of achieving long-term
sustained viral response (Dieterich andSpivak, 2003).
Reddy et al, (2007) reported that minor ribavirin dose reduction to
manage adverse events do not appear to affect sustained virological
response adversely, unless cumulative exposure is less than 60%.
Increasing evidence now supports the use of recombinant human
erythropoietin to manage anemia in these patients, with the objective of
maintaining the RBV dose (Sherman et al, 2006) .