Management of virus-induced systemic vasculitides

Abstract

The best therapeutic strategy in virus-induced vasculitides should take into account the etiology of the disease and be adapted to the pathogenesis. The combination of antiviral treatments and plasma exchanges has been proven effective in polyarteritis nodosa. In HIV-related vasculitis, this strategy is effective and does not jeopardize the outcome of AIDS, as do cytotoxic agents. In vasculitis related to hepatitis C virus-associated cryoglobulinemia, plasma exchanges improve the outcome, but the poor effectiveness of antiviral drugs usually does not favor a definite recovery of the patients. Relapses are frequent.

Systemic vasculitides: Some debatable aspects of the problem

“…Хотя этиологические факторы большинства первичных васкулитов остаются неизвест-ными, не исключается роль вирусов -цитомегаловируса, вируса гепатита А, В, С, вируса иммунодефицита человека (ВИЧ), пар-вовируса, вируса Эпштейна-Барр и ряда бактерий, чаще грам-положительных, а также паразитарных и грибковых инфекций как пусковых факторов развития СВ [30][31][32][33][34].…”

Infection-related vasculitis

“…Conventional therapy with steroids and immunosuppressive agents may control HBV-PAN, but their prolonged use exerts deleterious effects by enhancing viral replication and further progression to cirrhosis in chronic hepatitis B [11]. With this in mind, Guillevin and Cohen [11] had devised clever and effective therapeutic strategies based on short-term corticosteroids, followed-up by the combination of plasma exchanges and antiviral agents such as vidarabine and interferon (IFN)-2α.…”

“…With this in mind, Guillevin and Cohen [11] had devised clever and effective therapeutic strategies based on short-term corticosteroids, followed-up by the combination of plasma exchanges and antiviral agents such as vidarabine and interferon (IFN)-2α. These authors, more recently have assessed the efficacy and safety of lamivudine, combined with plasma exchanges after short-term corticosteroids for HBV-associated PAN [12•].…”

“…Unfortunately, the majority of patients (70%) relapse after cessation of therapy, and a sustained clinical response is seen in only 20%. Plasma exchanges improve the outcome [28][29][30].…”

A review of cardiovascular complications accompanying AIDS

“…41 They are not correlated with the production of circulating cryoglobulins induced by HIV, but instead are induced in the case of HCV coinfection. 42 Moreover some concomitant opportunistic infections can directly or indirectly produce vessel alterations and this occurs also because of the chronic inflammatory stimulation induced by HIV infection.…”