scholarly journals Hepatitis C Virus, Cryoglobulinemia, and Kidney: Novel Evidence

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Fabrizio Fabrizi
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Immunosuppressive Therapy ◽  
Systemic Vasculitis ◽  
Antiviral Treatment ◽  
Mixed Cryoglobulinemia ◽  
Cytotoxic Agents ◽  
Type I ◽  
Wide Range ◽  
Cryoglobulinemic Glomerulonephritis

Hepatitis C virus infection can lead to chronic active hepatitis, cirrhosis, and liver failure; however, it is also associated with a wide range of extra-hepatic complications. HCV is associated with a large spectrum of histopathological lesions in both native and transplanted kidneys, and it is increasingly recognized as an instigator of B cell lympho-proliferative disorders including mixed cryoglobulinemia. Mixed cyoglobulinemia is a systemic vasculitis primarily mediated by immune complexes; it is characterized by variable organ involvement including skin lesions, chronic hepatitis, glomerulonephritis, peripheral neuropathy, and arthralgias. The most frequent HCV-associated nephropathy is type I membranoproliferative glomerulonephritis, usually in the context of type II mixed cryoglobulinemia. Various approaches have been tried for the treatment of HCV-related glomerulonephritis, including immunosuppressive therapy (corticosteroids and cytotoxic agents), plasma exchange and antiviral agents. Data on the antiviral treatment of HCV-associated glomerulonephritis are not abundant but encouraging results have been provided. Immunosuppressive therapy is particularly recommended for cryoglobulinemic kidney disease. Recent evidence has been accumulated on rituximab therapy for HCV-related cryoglobulinemic glomerulonephritis exists but several questions related to its use remain unclear. Distinct approaches should be considered for the treatment of HCV-associated cryoglobulinemic glomerulonephritis according to the level of proteinuria and kidney failure.

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

2011 ◽  
Vol 6 (3) ◽  
pp. 606-612 ◽  
Author(s):  
Hisham R. El Khayat ◽  
Yasser M. Fouad ◽  
Ezzat Ali Ahmad ◽  
Hussein El Amin ◽  
Faten Ismael ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Treatment ◽  
Mixed Cryoglobulinemia ◽  
Virus Genotype ◽  
Genotype 4

scholarly journals Correlation of clinical and virologic responses to antiviral treatment and regulatory T cell evolution in patients with hepatitis C virus-induced mixed cryoglobulinemia vasculitis

2008 ◽  
Vol 58 (9) ◽  
pp. 2897-2907 ◽  
Author(s):  
Dan-Avi Landau ◽  
Michelle Rosenzwajg ◽  
David Saadoun ◽  
Hélène Trébeden-Negre ◽  
David Klatzmann ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
T Cell ◽  
Regulatory T Cell ◽  
Antiviral Treatment ◽  
Mixed Cryoglobulinemia ◽  
Cell Evolution

scholarly journals Treatment of chronic hepatitis C-associated cryoglobulinemia vasculitis at the era of direct-acting antivirals

2020 ◽  
Vol 13 ◽  
pp. 175628482094261 ◽  
Author(s):  
Cloé Comarmond ◽  
Patrice Cacoub ◽  
David Saadoun
Keyword(s):  
Hepatitis C ◽  
Clinical Symptoms ◽  
Systemic Vasculitis ◽  
Mixed Cryoglobulinemia ◽  
Organ Damage ◽  
Hcv Infection ◽  
Direct Acting Antivirals ◽  
Extrahepatic Manifestations ◽  
Wide Range ◽  
Direct Acting

Hepatitis C virus (HCV) infection is responsible for both hepatic and extrahepatic manifestations. Before the era of direct-acting antivirals (DAA), cryoglobulinemia was related to HCV infection in 70–90% of cases. Observed in 30% to 40% of patients with hepatitis C, mixed cryoglobulinemia is mainly asymptomatic. Conversely, symptomatic cryoglobulinemia vasculitis (CV) can occur in 5–10% of patients with HCV-associated cryoglobulinemia. CV is a small-vessel systemic vasculitis, and organ damage results from circulation and precipitation of cryoglobulins and complement activation. A wide range of clinical symptoms can be observed during CV, and manifestations are potentially life-threatening. The most frequent manifestations occurring in CV are cutaneous, with recurrent purpura, articular with joint pains, neurologic with peripheric neuropathy, and renal with membranoproliferative glomerulonephritis. DAA have drastically changed chronic HCV therapy. DAA induce sustained virological response (SVR) rates greater than 95%, and also improve extrahepatic manifestations such as CV. We review recent studies investigating the clinical and immune effects of DAA therapy on HCV-CV.

Association between persistent lymphatic infection by hepatitis C virus after antiviral treatment and mixed cryoglobulinemia

Blood ◽  
2008 ◽  
Vol 111 (5) ◽  
pp. 2943-2945 ◽  
Author(s):  
Carlo Giannini ◽  
Antonio Petrarca ◽  
Monica Monti ◽  
Umberto Arena ◽  
Patrizio Caini ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Treatment ◽  
Mixed Cryoglobulinemia

scholarly journals ASSOCIATION BETWEEN CRYOGLOBULINEMIA AND THYROID DYSFUNCTION IN HEPATITIS C CARRIERS

2014 ◽  
Vol 2 (3) ◽  
Author(s):  
Luis Jesuino De Oliveira Andrade ◽  
Ajax Mercês Atta ◽  
Maria Luiza Brito de Sousa Atta ◽  
Raymundo Paraná
Keyword(s):  
Cohort Study ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Prospective Cohort ◽  
Thyroid Dysfunction ◽  
Antiviral Treatment ◽  
Mixed Cryoglobulinemia ◽  
Function Evaluation ◽  
Autoimmune Thyroid ◽  
Study Results

Introduction: Cryoglobulinemia is a biomarker of autoimmunity correlated with hepatitis C virus (HCV) infection. Objective: Report the association between the presence of mixed-cryoglobulinemia and thyroid dysfunction (TD) in hepatitis C virus carriers before and during treatment with pegylatedinterferon-alpha (Peg-IFN-α). Methods: Prospective cohort study. Results: Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Mean age of patients was 49.61 ± 11.83 years. Cryoglobulinemia was demonstrated in 24 (36.92%) patients. The TD was demonstrated in 2 patients (3.10%) before treatment with IFN-α, in 4 patients (6.20%) at 12th week, and 8 patients (12.30%) at 24th week; whereas autoimmune thyroid (TPO-Ab) positive was demonstrated in 3 patients (4.60%) before treatment, in 7 patients (10.80%) at 12th week, and 12 patients (18.50%) at 24th week. In the sample analyzed, the risk of a patient with cryoglobulinemia develop TD was 2.74 (95% CI: 1.95–12.95) times that of a patient without cryoglobulinemia in the 12th week of treatment and 1.83 (95% CI: 1.03–7.08) times in the 24th week of antiviral treatment, and risk of a patient with cryoglobulinemia for develop TPO Ab positive was 2.44 (95% CI: 1.46–5.98) times that of a patient without cryoglobulinemia in the 12th week of treatment, and 1.31 (95% CI: 1.05–2.89) times in the 24th weeks of antiviral treatment. Conclusion: We concluded that thyroid function evaluation should be recommended for HCV carriers that are seropositive for cryoglobulinemia.

Systemic Vasculitis in Patients with Hepatitis C Virus Infection with and without Detectable Mixed Cryoglobulinemia

2010 ◽  
Vol 38 (1) ◽  
pp. 104-110 ◽  
Author(s):  
BENJAMIN TERRIER ◽  
DAMIEN SÈNE ◽  
AGNÈS DECHARTRES ◽  
DAVID SAADOUN ◽  
NICOLAS ORTONNE ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Clinical Response ◽  
Systemic Vasculitis ◽  
Mixed Cryoglobulinemia ◽  
Hcv Rna ◽  
Hepatitis C Virus Infection ◽  
Immunofluorescence Analysis ◽  
Clinical Difference ◽  
Median Serum

Objective.To describe hepatitis C virus (HCV)-related systemic vasculitis in patients without detectable mixed cryoglobulinemia (MC) and to compare them to typical cases of HCV-MC vasculitis.Methods.Twelve HCV RNA+ patients with histologically proven vasculitis in the absence of detectable MC (cases) were retrospectively compared with 48 HCV RNA+ patients with MC vasculitis (controls). Each case was matched with 4 controls for age and sex.Results.The main epidemiological and virologic features were similar between cases and controls. No clinical difference was found, except for lower rates of arthralgias (33% vs 71%; p = 0.02) and purpura (50% vs 83%; p = 0.03) in cases. Cases showed higher mean serum C3 (1.17 ± 0.21 vs 0.93 ± 0.23 g/l; p = 0.01) and median C4 levels (0.25 vs 0.04 g/l; p < 0.001), lower median serum IgM levels (0.6 vs 1.9 g/l; p < 0.001), and lower rates of rheumatoid factor positivity (8% vs 82%; p < 0.001) than controls. The main histologic features were similar between cases and controls. Immunofluorescence analysis of skin biopsy from 1 case revealed perivascular deposits of C3 and IgA. After treatment, overall clinical response of vasculitis (75% vs 83%) and sustained virological response (40% vs 64%; p = 0.3) were similar between cases and controls, except for higher complete clinical response (42% vs 73%; p = 0.05) in controls.Conclusion.HCV-related systemic vasculitis may occur in the absence of detectable MC. Our findings suggest that such vasculitis probably results from immune complex-mediated mechanisms, and that the therapeutic management of such vasculitis should be similar to that of HCV-MC vasculitis.

Genetic polymorphisms as the predictors of response to antiviral treatment in chronic hepatitis C virus infection

2011 ◽  
Vol 152 (22) ◽  
pp. 876-881
Author(s):  
Alajos Pár
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Genetic Polymorphisms ◽  
Chronic Hepatitis C ◽  
Genome Wide Association Study ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Snp Analysis ◽  
Chronic Hcv

The review discusses the genetic polymorphisms involved in the pathogenesis of hepatitis C virus (HCV) infection, that may determine the outcome of disease. In this field earlier both certain major histocompatibility complex (MHC) alleles and some cytokine gene variants have also been studied. Recently, the genome-wide association study (GWAS) and targeted single nucleotide polymorphism (SNP) analysis have revealed that a variant in the promoter region of interleukin-28B (IL-28B) gene is strongly linked to viral clearance and it may be the strongest pretreatment predictor of treatment response in chronic hepatitis C. Last year it was shown that two genetic variants leading to inosine triphosphatase deficiency protect against haemolytic anemia in patients receiving ribavirin during antiviral treatment for chronic HCV infection. Orv. Hetil., 2011, 152, 876–881.

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