Presentation: Cryoglobulinemic Vasculitis in Patients with Chronic HCV Infection. Influence of HCV-RNA Load, HCV Genotype and HIV Coinfection (2007)

2006 Cryoglobulinemic Vasculitis in Patients with Chronic HCV Infection. Influence of HCV-RNA Load, HCV Genotype and HIV Coinfection

PURPOSE. To determine whether the clinical and immunological expression of patients with cryoglobulinemia associated with chronic hepatitis C virus (HCV) infection varied according to HCV-RNA load, HCV genotype or HIV coinfection.
METHODS. We studied 340 HCV patients (188 women and 152 men, with a mean age of 49 years) consecutively diagnosed with cryoglobulinemia between 1993 and 2003 in our hospital. HCV infection was confirmed by serum HCV-RNA determination in all patients.
RESULTS. Two hundred and forty eight (73%) patients had asymptomatic cryoglobulinemia and 92 (27%) presented cryoglobulinemic symptoms. Patients with genotype 1 had a higher mean age at diagnosis of cryoglobulinemia (48.2 vs 40.2 yrs, p<0.001) and a higher prevalence of cryoglobulinemic symptoms (25% vs 10%, p=0.02), especially of vasculitic features (19% vs 5%, p=0.014). In comparison with monoinfected HCV patients, those with HIV coinfection had a lower mean age at diagnosis of cryoglobulinemia (40.4 vs 52.8 yrs, p<0.001), a lower prevalence of cryoglobulinemic symptoms (15% vs 34%, p<0.001), vasculitis (10% vs 28%, p<0.001), associated systemic autoimmune disease (3% vs 14%, p=0.001), RF (30% vs 70%, p=0.001) and hypocomplementemia (50% vs 78%, p=0.01). In HCV-HIV patients, a high viral load was associated with a high frequency of symptomatic cryoglobulinemia, especially in patients with a high viral load of the two viruses (50% vs 7%, p=0.001)
CONCLUSION. A higher frequency of cryoglobulinemic symptoms (especially vasculitis) was found in patients with HCV monoinfection and in those carrying HCV genotype 1. In contrast, patients with HIV coinfection presented a three-fold lower prevalence of vasculitis. Associated HIV infection significantly attenuated the clinical and immunological expression of cryoglobulinemia, except in coinfected patients with high viral loads for the two viruses.

  M. Ramos-Casals, FIS-040701, 2; X. Forns, None; P. Brito-Zerón, None; A. Vargas, None; M. Ruiz, None; M. Laguno, None; J. Yagüe, None; J.M. Gatell, None; J.M. Sánchez-Tapias, None.