Clinical and immunological features of HCV/HIV co-infected patients with mixed cryoglobulinemia

Abstract

Mixed cryoglobulinemia (MC) is a systemic vasculitis leading to clinical manifestations ranging from MC syndrome (purpura, arthralgia, asthenia) to more serious lesions with neurologic and renal involvement. Hepatitis C virus (HCV) infection is associated with most cases of MC. While many other viral infections have been reported to cause MC vasculitis most of these reports are anecdotal. Cryoglobulins are detected in 17-26% of human immunodeficiency virus (HIV)-infected patients but are rarely associated with MC vasculitis. Several reports have found a higher cryoglobulin prevalence in HIV/HCV co-infected patients than in HCV patients. Case reports of MC vasculitis in HIV/HCV co-infected patients are extremely rare. The role of cellular immunity in the pathogenesis of MC vasculitis in HIV/HCV co-infected patients is supported by an initial CD4 cell counts >250/mm3 in all cases. Compared with HCV-MC patients, HIV/HCV-MC co-infected patients were younger, more frequently of male gender, and intravenous drug users. They had higher HCV RNA level, liver necroinflammation, and gammaglobulin levels, and a lower cryoglobulin level. However, the clinical manifestations of MC vasculitis in co-infected patients did not differ significantly from those in HCV mono-infected patients. A beneficial effect of anti-HCV therapy was evidenced in HIV/HCV co-infected patients with MC vasculitis.