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Background  A decline in hemoglobin (Hb) concentration during antiviral therapy in chronic hepatitis C (CHC) is a serious side effect. It may compel to dose reduction or even termination of antiviral treatment. The activation of erythropoietin (EPO) synthesis as a physiological response to anemia and its relation to a genetic variation within the EPO gene has not been evaluated yet.    Methods  Data of 348 CHC patients were reviewed retrospectively. Samples were genotyped for  EPO  rs1617640 and  inosine triphosphatase  ( ITPA ) rs1127354. Serum EPO concentrations were determined before and during therapy. Primary endpoints were set as Hb decline >3 g/dl at weeks 4 and 12.    Results   EPO  rs1617640 G homozygotes showed a significantly lower rise of serum EPO level over time than T allele carriers (p < 0.001). The cumulative frequency of a significant Hb reduction added up to 40%. Multivariate analysis revealed that besides age, ribavirin starting dose and baseline Hb also  EPO  rs1617640 G homozygosity associates with Hb reduction at week 4 (p = 0.025) and 12 (p = 0.029), while  ITPA  C homozygotes are at risk for Hb decline particularly early during treatment. Furthermore,  EPO  rs1617640 G homozygotes were more frequently in need for blood transfusion, epoetin-α supplementation, or ribavirin dose reduction (p < 0.001).    Conclusions  Our data suggest that  EPO  rs1617640 genotype, the rise of serum EPO concentration as well as  ITPA  rs1127354 genotype are promising parameters to evaluate the Hb decline during antiviral therapy. A rational adjustment of therapy with epoetin-α supplementation might prevent serious adverse events or the need to terminate treatment.    Electronic supplementary material  The online version of this article (doi:10.1186/1471-2334-14-503) contains supplementary material, which is available to authorized users.

bmc infectious diseases

Erythropoietin rs1617640 G allele associates with an attenuated rise of serum erythropoietin and a marked decline of hemoglobin in hepatitis C patients undergoing antiviral therapy