The association of cryoglobulinaemia with sustained virological response in patients with chronic hepatitis C

Abstract

Previous reports suggest cryoglobulinemia might influence the hepatitis C virus (HCV) infection clinical course and treatment response but this association has not been thoroughly evaluated. We aimed to assess the relationship between cryoglobulinemia and sustained viral response (SVR) in patients treated for HCV infection. We included patients with HCV infection treated from January 2003 through December 2006. Biochemical analyses, detection cryoglobulinemia, and liver biopsies were performed prior to treatment. Genotype 1 or 4 infections received Peg-interferon (IFN) alpha-2a or -2b for 48 weeks; genotypes 2 or 3 received IFN alpha for 24 weeks. All patients also received ribavirin. Of 329 enrolled patients, 242 (73%) were male and the median age was 43 years. Cryoglobulinemia was detected in 196 (59.6%) patients; liver biopsy was performed in 301. Multivariate analysis showed an association of cryoglobulinemia with severe active necroinflammation (A3) (adjusted odds ratio [AOR] = 9.48; 95% confidence interval [CI]: 1.50-59.92) and rheumatoid factor (RF) level (AOR = 1.01; 95% CI: 1.00-1.02). Variables associated with advanced fibrosis were age, aspartate aminotransferase and alkaline phosphatase levels, alcohol use, and presence of diabetes. Variables independently associated with SVR were cryoglobulinemia (AOR = 2.33, 95% CI: 1.26-4.32), absence of cirrhosis (AOR = 4.5, 95% CI: 1.4-14.80), and RF level (AOR = 1.008, 95% CI: 1.001-1.014). Our findings suggest cryoglobulinemia is associated with severe necroinflammatory activity in HCV-infected patients. We also provide the first evidence for an association between cryoglobulinemia and higher SVR rates, highlighting its potential role as a prognostic factor for treatment response.

Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis

“…Further, subgroup analyses showed that the best outcomes were achieved in studies in which patients were either predominantly HIV-negative (HIV−), predominantly infected with an HCV genotype other than 1 or 4, or treated with ribavirin. The proportion of patients who achieved an SVR in the 20 studies that included patients with all three of these characteristics ranged from 45% (95% CI: 34-55) 70 to 78% (95% CI: 61-91) 71 and the pooled proportion was 65% (95% CI: [61][62][63][64][65][66][67][68]. The presence of the interleukin-28B polymorphism was associated with a high SVR rate in the two studies which reported relevant data.…”

Combined Effects of 2 Interleukin 28B Polymorphisms on the Therapeutic Outcome of Hepatitis C Patients With Circulating Cryoglobulins

“…The association between cryoglobulinemia and SVR in chronic hepatitis C has been previously investigated, leading to conflicting results. In fact, association between cryoglobulinemia and higher SVR rates has been reported in a Brazilian cohort 33 ; however, 2 recent studies have reported that cryoglobulinemia is negatively associated with SVR in chronic hepatitis C patients. 34 , 35 A further study reported that cryoglobulinemia is associated with low SVR rates in symptomatic patients, while asymptomatic MC presents with similar SVR rates than noncryoglobulinemic subjects.…”

HCV In At Risk Populations: Who Can be Treated and How?

“…Cyclophosphamide, rituximab, plasmapheresis and pulsed corticosteroids have been used to treat severe cryoglobulinemia in patients with HCV [73,74]. Interestingly, while cryoglobulinemia is associated with severe necroinflammatory activity in patients with HCV, its presence may be associated with higher SVR rates [75].…”