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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) . |