Ribavirin: Allow me to be more precise: A GI Specialist worth a damn MUST adjust down the initial dose to mitigate severe anemia; yet, a less than stellar Doc may not adjust UP the dose if anemia is deemed to be inconsequential to achieve greater VR.
In their defense, they may not adjust up if the currently available data suggests a higher dose is not more efficacious; however, most GI docs have so much on their plate that they may not be up-to-date on real-time peer-reviewed journal data. Also, the drug causes a host of other side-effects which may preclude "chancing" an uppage of dose.
(The hydrocortisone lifestyle, thought process alterations, etc.)
Life-threatening anemia drives the dosage. I inquired about Procrit-style mitigants... but the data at the time suggested no benefit and large expense on top of the already expensive treatment.