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
    • Department of GastroenterologyTheodore Bilharz Institute
    • Department of Tropical MedicineMinia University
  • Ezzat Ali Ahmad
    • Department of Internal MedicineAlexandria University
  • Hussein El Amin
    • Department of Internal MedicineAssiut University
  • Faten Ismael
    • Department RheumatologyMinia University
  • Amal Rizk
    • Department RheumatologyCairo University
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