Long-term course of patients with mixed cryoglobulinemia

Abstract

The long-term course of mixed cryoglobulinemia during hepatitis C virus (HCV) infection is a function of chronic viral antigenic stimulation of B cells. The natural tendency of mixed cryoglobulins (MC) is the transition from type III to oligoclonal type and finally to type II MC, which mostly exhibit rheumatoid factor activity and are frequently associated with vasculitis. Disease evolution after treatment depends on its efficacy in inducing viral clearance. Combined PEGylated interferon-α and ribavirin is the most efficient treatment, resulting in a complete immunological response in most patients when associated with viral clearance. The use of rituximab, which specifically targets B cells and thus MC production, was shown to result in clinical and immunological responses in most patients, but with a high rate of relapse after treatment due to viral persistence. More recently, a combination of rituximab and antiviral agents was shown to provide the best approach to the treatment of HCV-related MC vasculitis, as it achieves both viral clearance and B-cell depletion.