Abstract
The best therapeutic strategy in virus-induced vasculitides should take into account the etiology of the disease and be adapted to the pathogenesis. The combination of antiviral treatments and plasma exchanges has been proven effective in polyarteritis nodosa. In HIV-related vasculitis, this strategy is effective and does not jeopardize the outcome of AIDS, as do cytotoxic agents. In vasculitis related to hepatitis C virus-associated cryoglobulinemia, plasma exchanges improve the outcome, but the poor effectiveness of antiviral drugs usually does not favor a definite recovery of the patients. Relapses are frequent.
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References and Recommended Reading
Trépo CG, Thivolet J, Prince AM: Australia antigen and polyarteritis nodosa. Am J Dis Child 1972, 123:390–392.
Agnello V, Chung RT, Kaplan LM: A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med 1992, 327:1490–1495. Outstanding paper describing the responsibility of HCV in the occurrence of type II cryoglobulinemia.
Calabrese LH: Vasculitis and infection with the human immunodeficiency virus. Rheum Dis Clin North Am 1991, 17:131–147. This paper describes the clinical manifestations and outcome of patients with AIDS and systemic vasculitis.
Corman LC, Dolson DJ: Polyarteritis nodosa and parvovirus B19 infection. Lancet 1992, 339:491.
Guillevin L, Lhote F, Cohen P, et al.: Polyarteritis nodosa related to hepatitis B virus. A prospective study with longterm observation of 41 patients. Medicine (Baltimore) 1995, 74:238–53. A large series of patients with HBV-related PAN is described. The patients were included in prospective studies testing the indication of antiviral treatments. The results of this strategy are analyzed.
Trépo C, Thivolet J: Hepatitis associated antigen and periarteritis nodosa (PAN). Vox Sang 1970, 19:410–411.
Quint L, Deny P, Guillevin L, et al.: Hepatitis C virus in patients with polyarteritis nodosa. Prevalence in 38 patients. Clin Exp Rheumatol 1991, 9:253–257.
Carson CW, Conn DL, Czaja AJ, et al.: Frequency and significance of antibodies to hepatitis C virus in polyarteritis nodosa. J Rheumatol 1993, 20:304–309.
Servant A, Bogard M, Delaugerre C, et al.: GB virus C in systemic medium- and small-vessel necrotizing vasculitides. Br J Rheumatol 1998, 37:1292–1294.
Cacoub P, Maisonobe T, Thibault V, et al.: Systemic vasculitis in patients with hepatitis C. J Rheumatol 2001, 28:109–118.
Finkel TH, Torok TJ, Ferguson PJ, et al.: Chronic parvovirus B19 infection and systemic necrotising vasculitis: Opportunistic infection or aetiological agent? Lancet 1994, 343:1255–1258.
Leruez-Ville M, Lauge A, Morinet F, et al.: Polyarteritis nodosa and parvovirus B19. Lancet 1994, 344:263–264.
Calabrese LH, Hoffman GS, Guillevin L: Therapy of resistant systemic necrotizing vasculitis. Polyarteritis, Churg-Strauss syndrome, Wegener’s granulomatosis, and hypersensitivity vasculitis group disorders. Rheum Dis Clin North Am 1995, 21:41–57.
Gherardi R, Belec L, Mhiri C, et al.: The spectrum of vasculitis in human immunodeficiency virus-infected patients. A clinicopathologic evaluation. Arthritis Rheum 1993, 36:1164–1174. The authors describe vasculitides occurring in patients with HIV infection. They show the diversity of vasculitis associated with HIV infection.
Gisselbrecht M, Cohen P, Lortholary O, et al.: Human immunodeficiency virus-related vasculitis: clinical presentation of and therapeutic approach to eight cases. Ann Med Interne (Paris) 1998, 149:398–405. The authors describe a series of eight patients affected with HIVvasculitis. All were treated with plasma exchanges and antiviral treatment. This study shows that a recovery of vasculitis can be obtained without impairing the course of AIDS.
Gayraud M, Guillevin L, Le Toumelin P, et al.: Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. French Vasculitis Study Group. Arthritis Rheum 2001, 44:666–675. The prognostic factors and outcome of systemic vasculitides are described, focusing on the different treatment strategies. The paper analyzes the long-term outcome of HBV-PAN.
McMahon BJ, Heyward WL, Templin DW, et al.: Hepatitis Bassociated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up. Hepatology 1989, 9:97–101.
Guillevin L, Jarrousse B, Lok C, et al.: Longterm followup after treatment of polyarteritis nodosa and Churg-Strauss angiitis with comparison of steroids, plasma exchange and cyclophosphamide to steroids and plasma exchange: a prospective randomized trial of 71 patients. The Cooperative Study Group for Polyarteritis Nodosa. J Rheumatol 1991, 18:567–574.
Guillevin L, Merrouche Y, Gayraud M, et al.: Periarteritis nodosa related to hepatitis B virus. Determination of a new therapeutic strategy: 13 cases. Presse Med 1988, 17:1522–1526.
Trépo C, Ouzan D, Delmont J, Tremisi J: Superiority of a new etiopathogenic treatment curing periarteritis nodosa caused by hepatitis B virus, using a combination of brief corticotherapy, vidarabine and plasma exchange. Presse Med 1988, 17:1527–1531.
Guillevin L, Lhote F, Jarrousse B, et al.: Polyarteritis nodosa related to hepatitis B virus: a retrospective study of 66 patients. Ann Med Interne (Paris) 1992, 143:63–74.
Guillevin L, Lhote F, Leon A, et al.: Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges: a prospective trial in 33 patients. J Rheumatol 1993, 20:289–298.
Guillevin L, Lhote F, Sauvaget F, et al.: Treatment of polyarteritis nodosa related to hepatitis B virus with interferon-alpha and plasma exchanges. Ann Rheum Dis 1994, 53:334–337.
Avsar E, Savas B, Tozun N, et al.: Successful treatment of polyarteritis nodosa related to hepatitis B virus with interferon alpha as first-line therapy. J Hepatol 1998, 28:525–526.
Kruger M, Boker KH, Zeidler H, Manns MP: Treatment of hepatitis B-related polyarteritis nodosa with famciclovir and interferon alfa-2b. J Hepatol 1997, 26:935–939.
Wicki J, Olivieri J, Pizzolato G, et al.: Successful treatment of polyarteritis nodosa related to hepatitis B virus with a combination of lamivudine and interferon alpha. Rheumatology (Oxford) 1999, 38:183–185.
Lhote F, Guillevin L, Bussel A, et al.: Side effects of therapeutic plasma exchange during treatment of polyarteritis nodosa. Comparison of filtration and centrifugation. 718 sessions in 63 patients. Life Support Syst 1987, 5:359–366.
Fauvelle F, Leon A, Nicolas P, et al.: Pharmacokinetics of vidarabine in the treatment of polyarteritis nodosa. Fundam Clin Pharmacol 1992, 6:11–15.
Poynard T, Marcellin P, Lee S, et al.: Randomized trial of interferon alpha 2b plus ribavirin for 48 weeks or for 24 weeks versus alpha 2b plus placebo for 48 weeks for treatment of chronic hepatitis C virus. Lancet 1998, 352:1426–1432.
Zeuzem S, Feinman S, Rasenack J, et al.: Peginterferon alpha-2a in patients with chronic hepatitis C. N Engl J Med 2000, 343:1666–1672.
Cohen P, Nguyen QT, Deny P, et al.: Treatment of mixed cryoglobulinemia with recombinant interferon alpha and adjuvant therapies: a prospective study on 20 patients. Ann Med Interne 1996, 147:81–86.
Ferri C, Marzo E, Longombardo G, et al.: Interferon-alpha in mixed cryoglobulinemia patients: a randomized, crossovercontrolled trial. Blood 1993, 81:1132–1136. The first trial testing the indication of HCV in mixed cryoglobulinemia. The study shows the short-term response to the treatment and the limitations to the treatment in the long term.
Roithinger FX, Allinger S, Kirchgatterer A, et al.: A lethal course of chronic hepatitis C, glomerulonephritis, and pulmonary vasculitis unresponsive to interferon treatment. Am J Gastroenterol 1995, 90:1006–1008.
Meyer MF, Hellmich B, Kotterba S, Schatz H: Cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection? Rheumatol Int 2000, 20:35–38.
Gisselbrecht M, Cohen P, Lortholary O, et al.: HIV-related vasculitis: clinical presentation and therapeutic approach on six patients. AIDS 1997, 11:121–123.
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Guillevin, L., Cohen, P. Management of virus-induced systemic vasculitides. Curr Rheumatol Rep 4, 60–66 (2002). https://doi.org/10.1007/s11926-002-0025-x
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DOI: https://doi.org/10.1007/s11926-002-0025-x