Hepatology International

, Volume 6, Issue 3, pp 606–612

Hepatitis C virus (genotype 4)-associated mixed cryoglobulinemia vasculitis: effects of antiviral treatment

  • Hisham R. El Khayat
  • Yasser M. Fouad
  • Ezzat Ali Ahmad
  • Hussein El Amin
  • Faten Ismael
  • Amal Rizk
Original Article

DOI: 10.1007/s12072-011-9303-x

Cite this article as:
El Khayat, H.R., Fouad, Y.M., Ahmad, E.A. et al. Hepatol Int (2012) 6: 606. doi:10.1007/s12072-011-9303-x



Type II mixed cryoglobulinemia (MC) is a systemic vasculitis usually associated with hepatitis C virus (HCV). The present trial was performed to investigate the efficacy of therapy with pegylated interferon alfa-2a (PEG-IFN alfa-2a) plus ribavirin in patients with HCV-related MC vasculitis and evaluate the factors associated with clinical remission of MC.


A total of 46 consecutive patients with HCV-related Type II MC received PEG-IFN alfa-2a (standard dose 180 mg/week) subcutaneously plus oral ribavirin (800–1,200 mg/day) for 48 weeks. The response to treatment was analyzed by comparing clinical, immunologic, and virologic parameters at the initial evaluation with those observed at the end of follow-up. Logistic regression was used to assess the factors associated with clinical remission.


A total of 22 patients (48%) had a sustained virologic response and were complete clinical responders. Serum cryoglobulin disappeared in 26 of 46 patients (56%), and complement levels normalized in 70% of the patients. In univariate analysis, factors associated with complete clinical response were early virologic response at 4 weeks [OR 1.4 (95% CI 0.1–17.1)], proteinuria [OR 1.4 (95% CI 0.2–8.2)] and the fibrosis score [OR 1.09 (95% CI 0.6–1.9)], peripheral neuropathy [OR 0.9 (95% CI 0.1–6.5)], arthralgia [OR 0.7 (95% CI 0.1–3.9)], sicca syndrome [OR 0.6 (95% CI 0.1–3.2)], cryoglobulin [OR 0.2 (95% CI 0.07–1.09)], and purpura [OR 0.1 (95% CI 0.01–1.3)]. In multivariate analysis, only cryoglobulinemia was independently associated with complete clinical response. No patient had side effects for which discontinuation of therapy was required.


The results indicated that treatment with PEG-IFN alfa-2a plus ribavirin can achieve a complete clinical response in patients with HCV-related MC. Complete clinical response correlates with the eradication of HCV.


CryoglobulinemiaHepatitis CInterferon

Copyright information

© Asian Pacific Association for the Study of the Liver 2011

Authors and Affiliations

  • Hisham R. El Khayat
    • 1
  • Yasser M. Fouad
    • 2
  • Ezzat Ali Ahmad
    • 3
  • Hussein El Amin
    • 4
  • Faten Ismael
    • 5
  • Amal Rizk
    • 6
  1. 1.Department of GastroenterologyTheodore Bilharz InstituteCairoEgypt
  2. 2.Department of Tropical MedicineMinia UniversityMiniaEgypt
  3. 3.Department of Internal MedicineAlexandria UniversityAlexandriaEgypt
  4. 4.Department of Internal MedicineAssiut UniversityAssiutEgypt
  5. 5.Department RheumatologyMinia UniversityMiniaEgypt
  6. 6.Department RheumatologyCairo UniversityCairoEgypt