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Hepatitis C virus (genotype 4)-associated mixed cryoglobulinemia vasculitis: effects of antiviral treatment

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Abstract

Objective

Type II mixed cryoglobulinemia (MC) is a systemic vasculitis usually associated with hepatitis C virus (HCV). The present trial was performed to investigate the efficacy of therapy with pegylated interferon alfa-2a (PEG-IFN alfa-2a) plus ribavirin in patients with HCV-related MC vasculitis and evaluate the factors associated with clinical remission of MC.

Methods

A total of 46 consecutive patients with HCV-related Type II MC received PEG-IFN alfa-2a (standard dose 180 mg/week) subcutaneously plus oral ribavirin (800–1,200 mg/day) for 48 weeks. The response to treatment was analyzed by comparing clinical, immunologic, and virologic parameters at the initial evaluation with those observed at the end of follow-up. Logistic regression was used to assess the factors associated with clinical remission.

Results

A total of 22 patients (48%) had a sustained virologic response and were complete clinical responders. Serum cryoglobulin disappeared in 26 of 46 patients (56%), and complement levels normalized in 70% of the patients. In univariate analysis, factors associated with complete clinical response were early virologic response at 4 weeks [OR 1.4 (95% CI 0.1–17.1)], proteinuria [OR 1.4 (95% CI 0.2–8.2)] and the fibrosis score [OR 1.09 (95% CI 0.6–1.9)], peripheral neuropathy [OR 0.9 (95% CI 0.1–6.5)], arthralgia [OR 0.7 (95% CI 0.1–3.9)], sicca syndrome [OR 0.6 (95% CI 0.1–3.2)], cryoglobulin [OR 0.2 (95% CI 0.07–1.09)], and purpura [OR 0.1 (95% CI 0.01–1.3)]. In multivariate analysis, only cryoglobulinemia was independently associated with complete clinical response. No patient had side effects for which discontinuation of therapy was required.

Conclusion

The results indicated that treatment with PEG-IFN alfa-2a plus ribavirin can achieve a complete clinical response in patients with HCV-related MC. Complete clinical response correlates with the eradication of HCV.

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Authors and Affiliations

  1. Department of Gastroenterology, Theodore Bilharz Institute, Cairo, Egypt

    Hisham R. El Khayat

  2. Department of Tropical Medicine, Minia University, Minia, Egypt

    Yasser M. Fouad

  3. Department of Internal Medicine, Alexandria University, Alexandria, Egypt

    Ezzat Ali Ahmad

  4. Department of Internal Medicine, Assiut University, Assiut, Egypt

    Hussein El Amin

  5. Department Rheumatology, Minia University, Minia, Egypt

    Faten Ismael

  6. Department Rheumatology, Cairo University, Cairo, Egypt

    Amal Rizk

Authors
  1. Hisham R. El Khayat
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  2. Yasser M. Fouad
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  3. Ezzat Ali Ahmad
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  4. Hussein El Amin
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  5. Faten Ismael
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  6. Amal Rizk
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Corresponding author

Correspondence to Yasser M. Fouad.

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El Khayat, H.R., Fouad, Y.M., Ahmad, E.A. et al. Hepatitis C virus (genotype 4)-associated mixed cryoglobulinemia vasculitis: effects of antiviral treatment. Hepatol Int 6, 606–612 (2012). https://doi.org/10.1007/s12072-011-9303-x

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  • DOI: https://doi.org/10.1007/s12072-011-9303-x

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