Sustained response to interferon-alpha or to interferon-alpha plus ribavirin in hepatitis C virus-associated symptomatic mixed cryoglobulinaemia

Background: Hepatitis C virus (HCV) infection has been associated with mixe d cryoglobulinaemia. Aim: To investigate the efficacy of anti-viral therapy on the eradication o f HCV and its clinical manifestations in patients with HCV-associated sympt omatic mixed cryoglobulinaemia. Patients and methods: 18 out of 32 patients with symptomatic mixed cryoglob ulinaemia (MC group) received a 12-month course of interferon (3 MU three t imes a week. subcutaneously). Nonresponders or relapsers to this therapy we re treated with interferon plus ribavirin (1200 mg/day, orally) for 12-mont hs. 226 patients with HCV infection and without cryoglobulins were studied in comparison (Hepatitis C group). Serial quantification of serum HCV-RNA a nd cryoglobulins were performed. Results: In the MC group. 10 out of 18 patients (55%) receiving interferon showed an end of treatment response, but at the end of follow-up, only five (28%) patients had a sustained response. In the hepatitis C group, 91 pati ents (47%) showed an end of treatment response but only 42 (20%) a sustaine d response. In the MC group alanine transaminase, cryocrit and rheumatoid f actor decreased significantly in responders, with an improvement or dissape arance of the MC-associated clinical manifestations. Alanine transaminase, cryocrit and rheumatoid factor increased in the relapsers and the clinical manifestations reappeared. Nonresponders and relapsers to interferon in the MC group interferon plus ribavirin, Five out of eight nonresponders showed a end of treatment response but it was sustained in three of them. In the relapsers, treatment with combined therapy achieved a sustained response in four out of the Eve patients (80%). Conclusions: Interferon as monotherapy or combined with ribavirin is a safe and effective treatment in patients with HCV-associated MC, The presence o f cryoglobulins does not affect the response to anti-viral treatment in pat ients with HCV infection, The eradication of HCV is associated with an impr ovement or dissapearance of MC-associated clinical manifestations.