Persistence of Cryoglobulinemic Vasculitis after DAA Induced HCV Cure

Abstract

Treatment with a direct acting antiviral (DAA) has revolutionized HCV therapy, as more than 95% of patients achieve a sustained virological response (SVR). Cryoglobulinemic vasculitis (CryoVas), however, can persist and recur after the HCV cure. In this systematic review, we include data from 19 studies that provided information on the persistence and recurrence of CryoVas after the HCV cure with DAAs. A complete clinical response (CR) was reported in 63.7% to 90.2% of the DAA-treated patients after achieving SVR. Relapse of CryoVas symptoms was reported in 4% to 18% of the patients. Neuropathy, nephropathy, and dermatological complications were the most common manifestations of CryoVas. B-cell clones persisted in 31–40% of the patients and could contribute to CryoVas relapse. INFL3-rs12979860, ARNTL-rs648122, RETN-rs1423096, and SERPINE1-rs6976053 were associated with a higher incidence of persistence and recurrence of CryoVas. Prospective multicenter studies with diverse patient populations are needed to validate these findings for the timely and effective management of this challenging condition.

Hepatitis C Virus-associated Cryoglobulinemic Livedo Reticularis Improved with Direct-acting Antivirals

“…Just recently, a large systematic review of more than 621 cases in 19 papers reported that complete remission (CR) of HCV-MCV vasculitis after achieving SVR with DAA was seen in 63.7-90.2%, while relapse was seen in 4-18%, which is considered relatively favorable. However, B-cell clonal proliferation remained in 31-40% of cases, which may have contributed to the relapse of cryoglobulinemic vasculitis ( 33 ). Serologic relapse is defined in cases with cryoglobulin ＞1.5%, elevated rheumatoid factor (RF), or complement 4 (C4) detected after the initial reaction ( 33 ).…”

“…However, B-cell clonal proliferation remained in 31-40% of cases, which may have contributed to the relapse of cryoglobulinemic vasculitis ( 33 ). Serologic relapse is defined in cases with cryoglobulin ＞1.5%, elevated rheumatoid factor (RF), or complement 4 (C4) detected after the initial reaction ( 33 ). It is thought that regular performance of these examinations may lead to the early detection of HCV-MCV vasculitis recurrence.…”

Chronic Hepatitis C Virus Infection, Extrahepatic Disease and the Impact of New Direct-Acting Antivirals

“…Some other studies showed similar outcomes [ 74 , 75 ]. On the other hand, an SVR with DAAs may improve HCV-CV symptoms at six months, but patients could relapse at one year after antiretroviral therapy [ 76 , 77 ].…”

Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals

“…Relapses were detected in 4–18% of patients. Biomarkers associated with higher incidence of persistence or recurrence of CV were identified (INFL3-rs12979860, ARNTL-rs648122, RETN-rs1423096, and SERPINE1-rs6976053), but need further validation [ 70 ]. Interestingly, in a recent multicentric prospective study on data from the Italian Platform for the Study of Viral Hepatitis Therapy cohort, the authors reported self-reported clinical deterioration after an initial response in 49.6% of patients (median time of deterioration, 19 months) and that the rate of patients without any deterioration was 58% and 41% at 12 and 24 months, respectively [ 71 ].…”