Treating hepatitis C in patients with hemoglobinopathies

Introduction: Patients with hemoglobinopathies and chronic hepatitis C virus (HCV) infection are at high risk of developing severe liver disease. Anti-HCV therapies represent an important tool to modify the survival of these patients, since their life expectancy has significantly increased following the availability of iron chelation therapy. IFN-based regimens represented the standard of care before the recent approval of new direct antiviral agents. In 2009, the combination of pegylated (Peg)-IFN with ribavirin (RBV) replaced IFN monotherapy, leading to an improvement of therapy efficacy.Areas covered: We reviewed the available data published on patients with hemoglobinopathies and HCV chronic infection. Studies are heterogeneous, since patients with hemoglobinopathies underwent different anti-HCV regimens. We analyzed both efficacy and safety data, focusing on anemia, which might be worsened by the use of combined IFN/RBV, requiring modifications in transfusional schedules and iron chelation therapy.Expert opinion: The recent approval of IFN-free regimens has rapidly changed the scenario, since they are associated with overall high rates of sustained virological response and negligible side effects. However, these new drugs are very expensive thus limiting their access. Therefore, IFN and RBV will probably remain an acceptable therapeutic option for many patients, especially in underdeveloped countries.