A CLINICAL AND VIROLOGICAL STUDY OF HEPATITIS-C VIRUS-RELATED CRYOGLOBULINEMIA IN GERMANY

Background/Aims: Several reports, especially from Southern Europe, hav e demonstrated a close association between hepatitis C virus (HCV) inf ection and mixed cryoglobulinemia. In this study we have analyzed the significance of HCV-related cryoglobulinemia in Germany. Methods: Sera from 79 patients with cryoglobulinemia of type I (n=21), II (n=28) or III (n=30) were investigated for HCV markers. Furthermore, 132 consec utive patients with chronic hepatitis C were studied for the presence of cryoglobulins. Genotypes of HCV were determined according to Simmon ds, and HCV-RNA concentrations were measured in patients with and with out cryoglobulinemia. Results: In 79 patients with cryoglobulinemia we found anti-HCV antibodies in 17 (22%) and HCV-RNA in 11 patients (14% ), HCV antibodies were more frequent in essential (44%) compared to se condary mixed cryoglobulinemia (15%), In 132 patients with chronic HCV infection cryoglobulins were detected in 37 patients (28%), in 21 of them at low levels. Clinical symptoms due to cryoglobulinemia were obs erved in eight of the 37 patients, severe vasculitis in three patients with high cryocrit-levels and cryoprecipitation at room temperature. HCV genotype 1 and subtype Ib were most prevalent, both in patients wi th and without cryoglobulinemia, and mean HCV-RNA levels were not diff erent between the two groups. Comparison of HCV-RNA levels in cryoprec ipitates, supernatant and native serum suggests binding of HCV-RNA to the cryoprecipitate with different affinity in individual patients. Co nclusions: The lower prevalence of HCV-related cryoglobulinemia in our study compared with data from Italy and France suggests a south-north gradient in the prevalence of HCV-associated cryoglobulinemia in Euro pe.