Should HCV-Positive Asymptomatic Patients with Mixed Cryoglobulinemia Be Treated with Combined Antiviral Therapy?
Mixed cryoglobulinemia (MC) is a lymphoproliferative disorder resulting from immunoglobulin complexes that precipitate in serum in the cold. The disease is associated with a variety of vasculitic manifestations. HCV infection is considered one of the antigenic triggers of MC. HCV patients with circulating cryoglobulins and the absence of symptoms should be managed the same as HCV patients without this hematological condition, as the sustained virological response and safety profile are similar in the two groups of patients. Antiviral therapy with pegylated interferon and ribavirin is the first-line option for symptomatic HCV-related MC, with an excellent clinical response of cutaneous and rheumatologic manifestations and a partial effect on renal and neurologic complications, even without viral response. Viral eradication is usually accompanied by a maintained complete clinical and immunological response. Immunomodulatory agents, newly developed biologics therapy, and plasma exchange should be reserved for patients with severe or life-threatening manifestations. They provide temporary relief from the disease so that additional antiviral therapy can then be initiated.
KeywordsSustained Virological Response Antiviral Therapy Virological Response Sustained Virological Response Rate Mixed Cryoglobulinemia
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