Ribavirin in HIV/HCV co-infection
•Dose-dependent haemolytic anaemia:
↓ mean 2.5–3 g/dL Hb <4 weeks
•Drug–drug interactions
–Anti-HIV antagonism with pyrimidine nucleoside analogues:
AZT, D4T, ddC (in vitro)1,2
•Inhibits intracellular phosphorylation
–Increased intracellular levels of DDI metabolites (in vitro); increased risk for lactic acidosis
–Recent data suggest decreased SVR under abacavir treatment; but abacavir-treated patients had more fibrosis at baseline and were more HAART experienced3–5
1. Vogt MW. Science 1987;235:1376; 2. Baba AAC 1987;31:1613; 3. Margt NA and Miller MD, 2nd IAS Conference on HIV Pathogenesis and Treatment, Paris 2003; P980; 4. RIBAVIC Subanalyses CROI 2007; 5. CROI 2008
Slide Ribavirin in HIV/HCV Co-infection

Ribavirin causes anemia particularly in patients receiving AZT aNR other pyrimidine nucleoside analogs. The hemolytic anemia appears to be dose depeNRent aNR respoNRs to dose reduction or treatment with erythropoietin.