Background Ribavirin (RBV) is been used for SARS-CoV-2 infection. This drug is associated with a wide range of side effects, mainly anemia, so its use in patients with potential respiratory affectation could not be appropriate. The evidences of adverse events associated with RBV-use has mainly been derived in the context of hepatitis C (HCV) treatment, however the possible use of RBV in CoVID-19 patients could be limited to 14 days.

Methods Longitudinal study including HIV/HCV coinfected patients. We evaluate the hemoglobin dynamics and reductions as well as evaluate the development rate of anemia during the first 2 weeks of therapy in HCV infected patients.

Results 189 patients were included in the study. The median hemoglobin levels were 14.6 g/dL (IQR: 13.2-15.6 g/dL) and 13.5 g/dL (IQR: 12.3-14.5 g/dL) at weeks 1 and 2 of therapy, respectively. A cumulative number of 27 (14.2%) patients developed anemia (23 grade 1 [12.1%] and 4 grade 2 [2.1%]). We identify a baseline hemoglobin levels of 14 g/dL as the better cut-off to identify those patients with a high chance to develop anemia. Of the 132 patients with baseline hemoglobin level >14 g/dL, 8 developed anemia (6.1%) compared with 19 of 57 (33.3%) with hemoglobin levels lower than 14 g/dL (p < 0.001).

Conclusions Our study shows valuable information about the early hemoglobin kinetic timing in patients on RBV-therapy, that could be useful to tailor CoVID-19 treatment if RBV use is considered.

The authors have declared no competing interest.

This work was supported by the Ministerio de Sanidad (RD12/0017/0012) integrated in the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdireccion General de Evaluacion and the Fondo Europeo de Desarrollo Regional (FEDER). ARJ is the recipient of a Miguel Servet Research Contract by the Ministerio de Ciencia, Promocion y Universidades of Spain (CP18/00111). MF is the recipient of a Sara Borrell contract by the Ministerio de Ciencia, Promocion y Universidades of Spain (CD18/00091).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was designed and performed according to the Declaration of Helsinki. All patients provided written informed consent before included in the cohort. The study was approved by the Comite de Etica de Investigacion de Cordoba (D439/2010). All patients signed an Informed consent form in writing that gave permission to store and process their samples in the Biobanco del Hospital Universitario Reina Sofia de Cordoba (ISCIII reference: B.0000419), which is integrated into the Biobanco del Sistema Sanitario Publico de Andalucia, as well as to use of their clinical data for research.

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Raw data is available under reasonable request to corresponding author