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Cryoglobulinemia Related to Hepatitis C Virus Infection

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Abstract

A causal link among hepatitis C virus (HCV) infection and essential mixed cryoglobulinemia, cryoglobulinemic glomerulonephritis, and vasculitis is strongly supported. HCV triggers autoimmune response in predisposed individuals that manifests as organ-specific and non–organ-specific autoantibodies and as polyclonal/monoclonal rheumatoid factor, which has a central role in causing damaging cryoglobulin and immune complex tissue levels. Immunologic events are mainly induced by HCV infection persistence, with excessive immune stimulation. Humoral immune dysfunction leads to autoantibodies and rheumatoid factor production with cryoglobulinemia, glomerulonephritis, vasculitis, neuropathy, and probably thyroiditis, and arthritis in rare cases. Cellular immune dysfunction leads to lymphocytic infiltration, proliferation, and cytokine production. Pegylated (or not) interferon-alpha in combination with ribavirin appears to be the treatment of choice for patients with symptomatic essential mixed cryoglobulinemia with or without glomerulonephritis. Novel treatment with rituximab is promising.

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Authors and Affiliations

  1. Istituto di Clinica Medica, University of Sassari, Sassari, Italy

    Maria Pina Dore

  2. Dipartimento di Gastroenterologia, University of Verona, Verona, Italy

    Giovanna Fattovich

  3. Clinica Medica I, University of Padova, Padova, Italy

    Giuseppe Realdi

  4. Department of Pathology, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA

    Antonia R. Sepulveda

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  1. Maria Pina Dore
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  2. Giovanna Fattovich
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Dore, M.P., Fattovich, G., Sepulveda, A.R. et al. Cryoglobulinemia Related to Hepatitis C Virus Infection. Dig Dis Sci 52, 897–907 (2007). https://doi.org/10.1007/s10620-006-9510-9

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