The treatment of chronic viral hepatitis C has undergone three major milestones: the first was the application of short-acting interferon for the treatment of chronic hepatitis C; the second was short-acting interferon plus ribavirin for the treatment of chronic hepatitis C; and the third was long-acting interferon plus ribavirin for the treatment of chronic hepatitis C. The use of ribavirin has increased the effectiveness of interferon by approximately 10% to 20% and significantly reduced the relapse rate of hepatitis C. However, anemia is often encountered during the application of ribavirin. The main cause of anemia in treated hepatitis C patients is dual: the first is the process of hemolysis, the sudden lysis of red blood cells triggered by ribavirin; the second is the myelosuppression caused by interferon, which is a reaction of the organism to prevent ribavirin-induced anemia – the occurrence of myelosuppression. So it is two drugs, two induction mechanisms. Anemia is a hallmark of ribavirin exposure. There are data that clearly show that if anemia occurs during treatment, the patient has an increased chance of having a sustained virological response and a cure for hepatitis C. Therefore, it is not necessary to stop treatment as soon as anemia occurs. If a patient develops symptomatic anemia, there are two approaches. One is to add an erythropoietic growth factor, such as alfaibertin, to compensate for the anemia through a pharmacologic intervention. In the second approach, the dosage of ribavirin and/or interferon is reduced. In fact, dose-reduction therapy is better because when you add erythropoietic growth factors, your treatment costs and adverse effects will increase. Reduced dose therapy will reduce the adverse effects. Analyses have shown that tapering after viral regression has very little impact on obtaining a sustained virologic response. However, avoid tapering prior to viral regression because for most patients, this will diminish their ability to regress or delay regression. If a patient has had a viral regression and has experienced an adverse reaction, the best solution is to reduce the dose, which has very little effect after viral regression. If the anemia is severe, ribavirin needs to be temporarily discontinued and applied under monitoring after elevation.