Cryoglobulinemia in chronic hepatitis C: clinical aspects and response to treatment with interferon alpha and ribavirin
Rev. Inst. Med. Trop. Säo Paulo
; 49(2): 67-72, Mar.-Apr. 2007. tab
Article
in En
| LILACS
| ID: lil-449790
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ABSTRACT
INTRODUCTION:
The main extra-hepatic manifestation of hepatitis C is mixed cryoglobulinemia (MC). The aim of this study was to evaluate its prevalence among patients with chronic hepatitis C (CHC), to correlate its presence to host and virological variables and to the response to combined therapy with interferon-alpha and ribavirin. CASUISTIC ANDMETHODS:
202 CHC naive patients (136 with chronic hepatitis and 66 with cirrhosis) were consecutively evaluated for the presence of cryoglobulins. Cryoprecipitates were characterized by immunoelectrophoresis and classified according to the Brouet's criteria.RESULTS:
The prevalence of MC was 27 percent (54/202), and 24 percent of them (13/54) showed major clinical manifestation of the disease. Even though type III MC was more frequent (78 percent), symptomatic MC was more common in type II MC. The presence of cirrhosis (RR = 2.073; IC95 percent = 1.029 - 4.179; p = 0.041), and age of the patients (RR = 1.035; IC95 percent = 1.008 - 1.062; p = 0.01) were independently associated with the presence of cryoglobulins. No relationship was found with viral load and genotype. 102 patients were treated with interferon alpha and ribavirin. Among these, 31 had MC. Sustained virological response (around 30 percent) was similar in patients with and without MC (p = 0.971).CONCLUSION:
MC represents a prevalent complication in patients with CHC, specially older and cirrhotic patients. Only 24 percent of these patients show clinical manifestation of the disease, specially those with type II MC. The presence of MC did not affect the response to therapy.RESUMO
INTRODUÇÃO:
A crioglobulinemia mista (CM) representa importante complicação extra-hepática da hepatite C. Nesse estudo avaliamos sua prevelência em pacientes com hepatite C crônica (HCC) e relacionamos sua presença com aspectos clínicos e resposta ao tratamento com interferon alfa e ribavirina. CASUíSTICA EMÉTODOS:
202 pacientes consecutivos com HCC (136 com hepatite crônica e 66 com cirrose) foram avaliados para a presença de CM. Os crioprecipitados foram caracterizados por imunoeletroforese e classificados de acordo com BROUET et al.RESULTADOS:
A prevalência de CM nessa população foi de 27 por cento (54/202), e, desses, 24 por cento (13/54) apresentaram manifestações clínicas maiores da doença. Embora MC tipo III tenha sido a forma mais freqüentemente encontrada, a doença sintomática foi mais comum entre os pacientes com MC tipo II. A presença de cirrose (RR = 2,073; IC95 por cento = 1,029 - 4,179; p = 0,041) e a idade do paciente (RR = 1,035; IC95 por cento = 1,008 - 1,062; p = 0,01) estiveram independentemente associadas à presença de CM. Não houve associação entre a presença de CM e genótipo ou carga viral do vírus C. No total, 102 pacientes foram tratados com interferon alfa e ribavirina. Desses, 31 apresentavam CM. A resposta virológica sustentada (em torno de 30 por cento) não diferiu entre pacientes com e sem CM (p = 0,971).CONCLUSÃO:
CM é uma freqüente complicação na HCC, especialmente em pacientes com idade avançada e com cirrose hepática. Apenas 24 por cento desses pacientes apresentam manifestações clínicas da doença, sendo mais freqüentes entre portadores de CM tipo II. A presença de crioglobulinemia não afetou a resposta virológica ao tratamento com interferon alfa e ribavirina.
Full text:
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Index:
LILACS
Main subject:
Antiviral Agents
/
Ribavirin
/
Interferon-alpha
/
Hepatitis C, Chronic
/
Cryoglobulinemia
Type of study:
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
Language:
En
Journal:
Rev. Inst. Med. Trop. Säo Paulo
Journal subject:
MEDICINA TROPICAL
Year:
2007
Type:
Article