Chronic hepatitis C virus (HCV)
infection is associated with a variety of clinically important extrahepatic abnormalities. We have assessed the prevalence of
cryoglobulinemia and of the clinical syndrome associated with it in patients with chronic HCV
infection. We also have evaluated the clinical, serologic, and biochemical response to
antiviral treatment with
interferon-alpha (IFN-alpha). Eighty-one patients with chronic
liver disease associated with HCV
infection were included.
Cryoglobulins were sought in the serum. All patients were examined carefully for clinical manifestations of
cryoglobulinemia (e.g., palpable
purpura, Raynaud's syndrome,
arthritis,
peripheral neuropathy, Sjögren's syndrome,
glomerulonephritis).
Antiviral treatment with IFN-alpha, at a dose of 3 to 5 million units, 3 times weekly, was given to 20 patients with
cryoglobulinemia.
Cryoglobulins were detected in 45.7% of patients. Signs and symptoms of the clinical syndrome associated with
cryoglobulinemia were present in 12.3% of the entire group of patients (27% of the subgroup with detectable
cryoglobulins). Patients with
cryoglobulinemia were older (mean age, 56 +/- 15 vs. 44 +/- 16 years; p = 0.002) and had a higher rate of
cirrhosis (48.6% vs. 18.2%, rate ratio = 4.26, 95% confidence interval = 2.11 to 8.58, p = 0.00005) compared to patients without
cryoglobulinemia.
Cryoglobulins disappeared from the serum in 13 (65%) of the 20 patients who were treated for 6 to 12 months with IFN-alpha. This effect was affiliated in most patients with resolution of the clinical findings associated with
cryoglobulinemia and return of
transaminases to normal levels. Recurrence of
cryoglobulinemia was observed in two thirds of the patients who were observed
after treatment with IFN-alpha. We conclude that
cryoglobulins are present in 45.7% of patients with chronic HCV
infection. Symptoms or signs or both associated with the presence of
cryoglobulins develop in a high proportion (27%) of these patients.
Antiviral treatment with IFN-alpha leads to resolution of both
cryoglobulinemia and the symptoms associated with it in most patients who also show a biochemical response to
antiviral treatment. Recurrence is frequent
after treatment withdrawal.