Expert Opinion on Managing Chronic HCV in Patients with Mixed Cryoglobulinaemia Vasculitis

Zignego, Anna Linda; Pawlotsky, Jean‐Michel; Bondin, Mark; Cacoub, P.

doi:10.3851/imp3246

Cited by 11 publications

(9 citation statements)

References 45 publications

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“…Historically, the great majority (80-90%) of CryoVas cases were related to an HCV infection ; however, the recent development of all oral interferon (IFN)-free direct acting antiviral agents (DAA) has changed the landscape and incidence of CryoVas [8]. Viral clearance is associated with clinical improvement and therefore eradication of HCV should be a priority in the management of CryoVas [9]. Here, we review up-to-date data on HCV-related vasculitis.…”

Section: Competing Interestsmentioning

confidence: 99%

Hepatitis C virus-related vasculitis

Boleto¹,

Vieira²,

Saadoun³

et al. 2021

Clinics and Research in Hepatology and Gastroenterology

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Cryoglobulinemic vasculitis (CryoVas) is a small-to-medium vessel systemic vasculitis caused by the deposition of mixed cryoglobulins and immune complexes. Clinical spectrum of CryoVas ranges from mild symptoms to vasculitis involving multiple organs that may progress to more life-threatening ilness. Hepatitis C virus (HCV) chronic infection is the most frequent condition to be assessed in patients with CryoVas.The mortality rate among patients with HCV-associated CryoVas is 3× that of the general population, with a 63% 10-year survival rate. The recent advent of interferonfree direct-acting antivirals (DAAs), which have the potential to induce sustained virological response rates greater than 95%, has dramatically changed the management of chronic HCV infection and HCV-related CryoVas. B-cell depleting strategies, mainly with rituximab, are the main therapeutic option in severe and refractory cases of HCVassociated CryoVas. Despite the progress in the last years on the management of chronic HCV infection, there are still unmet needs regarding therapeutic management of severe and refractory HCV-associated CryoVas.

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Section: Competing Interestsmentioning

confidence: 99%

Hepatitis C virus-related vasculitis

Boleto¹,

Vieira²,

Saadoun³

et al. 2021

Clinics and Research in Hepatology and Gastroenterology

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“…Removal of circulating cryoglobulins by therapeutic plasmapheresis is accepted as an adjunctive therapy for fulminant cases or severe exacerbation of vasculitis, especially with rapidly progressive glomerulonephritis, central nervous system involvement, cardiac manifestations, ulcers or cutaneous necrotizing vasculitis. 47,48 Complementary and alternative therapies after treatments previously mentioned, are limited. Low-dose corticosteroids may help to control inflammatory symptoms such as articular manifestations but do not succeed in case of major organ involvement.…”

Section: Immune Restoration Following Daa Therapymentioning

confidence: 99%

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

Comarmond

Cacoub

Saadoun

2020

Therap Adv Gastroenterol

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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.

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“…Of note, cryoglobulinemia is found in 40% to 60% of HCV infected patients, and 10-35% of them will develop CryoVas manifestations [2]. The production of cryoglobulinemia is correlated with a long lasting HCV infection, older age and the degree of liver fibrosis [3]. Other chronic infectious disorders caused by human immunodeficiency viruses (HIV) or hepatitis B virus (HBV) or systemic autoimmune disorders [in particular Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE)] can also be associated with MC and CryoVas.…”

Section: Introductionmentioning

confidence: 99%

“…Five to 20% of patients with primary SS may present MC and CryoVas; such patients are at higher risk of B-cell lymphoma and have a relatively poor survival [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…IV, intravenous; PLEX, plasma exchange; GC, glucocorticoids; IL-2, interleukin-2 1. Severe kidney dysfunction, skin necrosis, involvement of the gastrointestinal tract or central nervous system;2 In cases of hepatitis B or HIV infection antiviral therapy should always be initiated before or at the same time as immunosuppressive therapy;3 In the presence of risk factors for rituximab-induced vasculitis flare (i.e. renal involvement, high levels of circulating cryoglobulin and low C4 levels) lower doses of rituximab should be used (250-500mg per infusion).…”

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