Clinical Reviews in Allergy & Immunology

, Volume 35, Issue 1, pp 30–39

Hepatitis C Virus Infection Induced Vasculitis

Article

DOI: 10.1007/s12016-007-8070-x

Cite this article as:
Cacoub, P. & Saadoun, D. Clinic Rev Allerg Immunol (2008) 35: 30. doi:10.1007/s12016-007-8070-x

Abstract

Cryoglobulinemia are immune complexes that may induce systemic cryoglobulinemic vasculitis, a small-vessel vasculitis involving the skin, the joints, the peripheral nerve system, and the kidneys. During the last 15 years, progresses have been done after the discovery of the hepatitis C virus, the main cause of cryoglobulins. Main factors associated with cryoglobulin production are female gender, alcohol intake above 50 g/day, extensive liver fibrosis, and steatosis. Symptomatic cryoglobulins (i.e., vasculitis) are associated with older age, longer duration of infection, and main characteristics of cryoglobulin (type II, IgM kappa, high serum levels). The physiopathology is complex, and it involves humoral immunity, B- and T-cellular immunity but not the virus itself. Peg-Interféron alpha Ribavirine combination leads to a virological and clinical response of the vasculitis in about 70% of patients. In nonresponders, recent open series suggested the efficacy of Rituximab* with a good response in up to 80% of patients but a relapse in 42% after 7 months after the last infusion. For future prospects and projects, new therapeutic strategies include a combination of best antiviral treatment with Peg-Interferon plus Ribavirin and Rituximab. Multicenter controlled trials are mandatory.

Keywords

Cryoglobulinemia Hepatitis C virus Vasculitis Interferon alpha Rituximab HCV infection Mixed cryoglobulinemia non-Hodgkin’s lymphoma 

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  1. 1.Université Pierre et Marie Curie-Paris 6ParisFrance
  2. 2.AP-HP, Hôpital Pitié-SalpêtrièreService de Médecine InterneParisFrance

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