HEPATITIS-C VIRUS GENOTYPE ANALYSIS IN PATIENTS WITH TYPE-II MIXED CRYOGLOBULINEMIA

Objective: To investigate the possible role of HCV variants in the pat hogenesis of mixed cryoglobulinemia. Setting: Medical service (rheumat ology and hepatology units) of urban, university-affiliate teaching ho spitals. Design: Analysis of vira I genotypes in a cohort of patients with hepatitis C virus (HCV) infection and mixed cryoglobulinemia. Pat ients: 90 unselected HCV-positive (anti-HCV antibody-positive and HCV RNA-positive) patients consecutively recruited at routine ambulatory v isits: 29 with and 61 without (control group) mixed cryoglobulinemia. Measurements: Clinical and histologic data; HCV RNA detection in serum and peripheral blood mononuclear cells by polymerase chain reaction ( PCR); HCV genotype determination by two methods based on genotype spec ific primer PCR and genotype-specific probe hybridization, respectivel y. Results: Persistent aminotransferase increases were found in 55% of patients with mixed cryoglobulinemia. Peripheral blood mononuclear ce lls were infected in 80% of cases. In serum samples, HCV genotype 2a/I II was detected with a higher prevalence in patients with mixed cryogl obulinemia than in controls (41% compared with 15%). The overall preva lence of genotype 2a/III in mixed cryoglobulinemia increased to 52% wh en findings in peripheral blood mononuclear cells were also considered . Among patients with mixed cryoglobulinemia, this genotype was more f requent in those without clinical and biochemical signs of liver disea se (85%) or with serum autoantibodies (75%). Conclusions: Mixed cryogl obulinemia may be related, at least in part, to the HCV genotype infec ting the host.