Case introduction: Patient He Moumou, male, 54 years old, Hunan, 6 years ago, due to recurrent gingival bleeding, visited the local hospital, found that platelet lowering, hepatitis C antibody positive, HCVRNA 4.3×105 copies/ml, genotype 1b. He was treated with interferon alpha antiviral therapy at a certain medical university and a hospital affiliated with a certain medical school, but relapsed after stopping the drug, and was admitted to our hospital for further treatment. After admission, he was diagnosed with hepatitis cirrhosis, compensated type C, hypersplenism, thrombocytopenia, and moderate anemia. Stage 1: Evaluation before antiviral therapy The patient’s liver function was classified as Child-pugh A. There was no history of hypertension, coronary heart disease, diabetes mellitus, psychiatric disease, or autoimmune disease, but the patient had anemia for a long time, with a hemoglobin of about 70-75 g/L, which might be aggravated by the application of ribavirin. Considering the patient’s past history of major gastrectomy, further anemia-related examinations were completed, and it was clearly identified as iron-deficiency anemia, and the hemoglobin quickly rose to 94g/L after targeted iron therapy. Phase II: interferon α combined with ribavirin antiviral therapy After careful evaluation, the antiviral treatment plan was formulated as follows: polyethylene glycol interferon α-2a 180μg subcutaneous injection once a week, ribavirin Ribavirin 600mg/d for the time being, and the expected course of treatment was 48 weeks. After 4 weeks of treatment, HCVRNA <15IU/ml (Roche), hemoglobin has risen to 110g/L, and ribavirin was increased to the full dosage of 1200mg/d. During the period of treatment, HCVRNA <15IU/ml (Roche), and all the laboratory indexes were in the safe range of the interferon α and ribavirin, the patient's 48-week course of treatment successfully ended, and the patient's outpatient follow-up for one year did not see any relapse. The patient's 48-week course of treatment was successfully completed, and he was followed up in the outpatient clinic for one year without any relapse. Return: clinical cure Physician's comment: 1. Do patients with hepatitis C cirrhosis need antiviral therapy? Numerous reports in the literature indicate that effective antiviral therapy can improve the survival of patients with hepatitis C cirrhosis. For patients with compensated cirrhosis, giving active antiviral therapy can significantly delay the progression of cirrhosis and reduce the occurrence of cirrhosis loss and hepatocellular carcinoma. 2. Selection of antiviral therapy drugs for hepatitis C? At present, pegylated interferon alpha combined with ribavirin is the standard regimen recommended by domestic and foreign experts for antiviral therapy of hepatitis C. Direct antiviral drugs (DAAs) are still in the clinical trial stage in China, but have good clinical application prospects. The combination of interferon α and ribavirin is better than single drug, and the efficacy of polyethylene glycol interferon α is better than ordinary interferon. In this case, the reason why the patient had multiple relapses on antiviral therapy in an outside hospital was related to his single application of plain interferon, so it is important to make adequate preparations to create conditions for antiviral therapy as much as possible. Choosing the right drug, ensuring the dosage and maintaining a sufficient course of treatment are the guarantees of effective antiviral therapy. 3.How do we look at the adverse reactions during antiviral therapy? The most common adverse reaction to interferon alpha is influenza-like symptoms, mostly occurring within 1 week, and the decline of white blood cells and platelets can be controlled by dose adjustment. A common adverse reaction to ribavirin is anemia. When anemia occurs, it should not only be considered as an adverse reaction to the drug, but also to look for the cause from multiple sources and target treatment. Under the close monitoring of experienced doctors, these adverse reactions are controllable, predictable and recoverable, and antiviral therapy should not be withheld for fear of adverse reactions.