Interferon‐α and ribavirin treatment in patients with hepatitis C virus–related systemic vasculitis

Abstract

Objective. Hepatitis C virus (HCV)-related vasculitis may involve multiple organs, including the skin, kidneys, and nervous system, and may be lifethreatening. Although HCV is increasingly recognized as a cause of systemic vasculitis, limited data are available regarding the optimal treatment of this potentially serious condition. Therefore, we retrospectively analyzed the response to treatment in patients with chronic hepatitis C complicated by systemic vasculitis who had received antiviral therapy with interferon-␣ (IFN␣) and ribavirin.Methods. This retrospective study included 27 patients with systemic vasculitis and chronic HCV infection. Each patient had received treatment with IFN␣ and ribavirin for at least 6 months. The response to antiviral treatment was analyzed by comparing clinical, immunologic, and virologic data at the time of entry and during followup. Clinical response was defined according to the evolution of weight, arthralgia, nervous system, renal system, and cutaneous involvement. The virologic and immunologic responses were defined by the absence of HCV RNA and the absence of cryoglobulinemia, respectively, both 6 months after stopping antiviral therapy and at the end of followup.Results. Patients received IFN␣ for a mean ؎ SD of 20 ؎ 14 months and ribavirin (at a mean ؎ SD dosage of 895 ؎ 250 mg/day) for 14 ؎ 12 months. Other treatments included low-dose corticosteroids and plasma exchange. After a mean ؎ SD followup of 57 ؎ 29 months, 25 of 27 patients are alive and are being followed up as outpatients. Because of the heterogeneity of anti-HCV treatments received, the main results were stratified according to patients with 6 months of followup after stopping antiviral treatment (group 1, n ‫؍‬ 14) and those who were still undergoing antiviral therapy at the time of analysis (group 2, n ‫؍‬ 13). Nine patients in group 1 had a sustained virologic response and were clinical and immunologic complete responders. Four patients in group 1 were virologic nonresponders, and 3 of these patients had partial clinical and immunologic responses. Overall, 10 patients in group 1 had a complete clinical and immunologic response of their vasculitis (all 9 of the sustained virologic responders and 1 of the 5 patients who remained viremic). At the end of followup, 7 patients in group 2 were negative for HCV RNA; 6 were complete clinical responders. Among the other 6 patients in group 2, who had persistent viremia, 4 had a partial clinical response. Among the patients in group 1, HCV RNA was more often undetectable and genotype 1 was less frequent in complete clinical responders compared with partial/ nonresponders. Age, sex, clinical vasculitic involvement, mean duration or total cumulative dose of IFN␣ or ribavirin, and use of steroids or plasmapheresis did not differ significantly according to clinical response.Conclusion. Treatment with IFN␣ and ribavirin can achieve a complete clinical response in most patients with HCV-related systemic vasculitis. Complete clinical response correlates with the eradicati...

Splenic lymphoma with villous lymphocytes, associated with type II cryoglobulinemia and HCV infection: a new entity?

“…Severe symptomatic MC may initially require treatment with steroids, immunosuppressive drugs, or plasma exchange. 17 In most cases, however, antiviral therapy led to the rapid disappearance of symptoms even when cryoglobulinemia and lymphoma were still detectable. Recently, Levine et al reported effective therapy against HCV in a case of HCV-associated mantle cell lymphoma.…”

PEGylated interferon alfa‐2b and ribavirin treatment in patients with hepatitis C virus–related systemic vasculitis

“…HCV antibodies and RNA were detected as previously described (8). HCV genotyping was performed using a second-generation line probe assay (LiPA; Innogenetics, Brussels, Belgium).…”

“…Liver biopsy specimens were evaluated according to the previously validated Metavir scoring system (14). Cryoglobulin levels were measured and classified as previously described (8). The immunologic evaluation included determination of RF and complement components, using standard methods.…”

“…Clinical improvement of HCV-related vasculitis correlates with virologic response, i.e., negative or significant decrease in the serum HCV RNA level. Combination therapy with IFN␣ plus ribavirin seems to provide much better short-and longterm results (8,9). In comparison with IFN␣ plus ribavirin, other treatment strategies (i.e., corticosteroids or cytotoxic agents) have not shown superior efficacy.…”

Hepatitis C virus and autoimmunity

“…The therapy has to eradicate the virus since treating the clinical manifestation leads only to a temporary control of the disease. Interestingly, studies have revealed that clinicoimmunological and virological response are generally strictly related [58]. It is suggested that IFN treatment, when successful, is able to help in preventing the evolution of HCV-associated MC LPDs [59].…”