"Hepatitis C Virus Infection and Mixed
Cryoglobulinemia"
Hepatitis C virus (HCV) is involved in an
increasing number of non-hepatic diseases. Mixed cryoglobulinemia (MC) is
considered a lymphoproliferative disorder. It is characterized by arthralgias,
weakness, purpura and organ involvement such as membranoproliferative
glomerulonephritis, peripheral neuropathy, vasculitis and chronic liver
diseases. The term essential mixed cryoglobulinemia (EMC) has been used to
describe the syndrome with no evidence of underlying disease. Chronic HCV
infection is the main cause (90%) of EMC type II and III with or without
clinical or biochemical evidence of liver damage. Anti-HCV antibodies, HCV
proteins and HCV-RNA have been found in the cryoprecipitate in concentrated
form. Several HCV genotypes are involved in the pathogenesis of the disease.
Cryoglobulinemia is quite frequent in chronic HCV infection and, when
appropriate, techniques of cryoglobulin detection are applied. Its frequency is
usually higher than 40%, with a mean cryocrit of approximately 2–5%.
Patients with chronic HCV infection and EMC are more frequently females,
cirrhotics and have a longer duration of HCV infection. Only a minority
(approximately 10%) is associated with clinical MC disease. HCV, as a
lymphotropic virus, may play a direct role in the development of low-grade
non-Hodgkin's lymphomas usually associated with EMC. Approximately 50% of
patients with hepatitis C associated MC appear to respond to interferon-alfa,
3–5 MU given three times weekly, for 12–18 months. A rebound
phenomenon of clinical and serologic parameters is frequently observed after
therapy discontinuation. HCV is also associated with membranoproliferative
glomerulonephritis, with or without cryoglobulinemia, or with membranous
glomerulonephritis, related to deposition of immune complexes within the
glomeruli. In conclusion, EMC associated with chronic HCV infection should no
longer be referred to as "essential" but rather as hepatitis C
associated MC. Every patient with chronic HCV infection may have MC. HCV is
added in the list of viruses causing glomerulonephritis.
Key words: Hepatitis C virus, cryoglobulinemia,
interferon-á, glomerulonephritis, non-Hodgkin's
lymphoma.
"Immunologic and Extrahepatic
Manifestations of HCV Infection"
Linda Scully, MD,Associate Professor,Department
of Medicine
University of Ottawa
"Hepatitis C Virus Infection and
Cryoglobulinemia"
Viral Hepatitis Reviews,Volume 2 Number 2, June
1996
F. Lunel, L. Musset
"Cryoglobulinemia in Chronic Hepatitis C
Virus Infection" (1995)
HAPS - Education Resources - Newsletters
"Cutaneous Vasculitis and Rheumatoid Factor
Positivity as Presenting Signs of Hepatitis C Virus-Induced Mixed
Cryoglobulinemia"
Archives of Dermatology
"Systemic Vasculitis: Pitfalls in Diagnosis
and Treatment"
Jeffrey R. Horvath, MD and Gary S. Hoffman,
MDThe Cleveland Clinic Foundation (MedScape Full Text Article)
"Systemic Vasculitis:
Diagnostic clues to this confusing array of
diseases"
Thomas M. Bush, MD
Vol 103 / No.2 / February 1998 / Postgraduate
Medicine
"Small-Vessel Vasculitis: Mixed
Cryoglobulinemia"
(photographs)
"Acute Inflammation Mediated by Immune
Complexes"
by Peter Slavkovsky
"Effects of Long-Term Course of
Alpha-Interferon in Patients with Chronic Hepatitis C Associated to Mixed
Cryoglobulinaemia"
European Journal of Gastroenterology and
Hepatology
"Hepatitis C Associated
Glomerulonephritis"
Dr. Richard Johnson, April 19, 1997
(clicking "cancel" offers access to
this article)
"HCV and Lymphoproliferative
Disorders"
The Cancer Journal - Volume 10, Number 2
(March-April 1997)
"Hepatitis C and Cancer"
Annals of Internal Medicine, 15 June
1997
"Viruses and Cancers: possible role of
hepatitis C virus"
Eur J Clin Invest 1997;27(9):711-8AD - Ferri C;
La Civita L; Zignego AL; Pasero GTI - Istituto Patologia Medica I, University of
Pisa, Italy.
"Chronic Hepatitis C and B-cell
non-Hodgkin's Lymphoma"
QJM: Monthly Journal of the Association of
Physicians, Volume 89, Issue 2: February 1996 -- Professor C. Ferri, Istituto
Patologia Medica I, University of Pisa, Via Roma 67, 56100 Pisa,
Italy