Hepatitis C virus (HCV) infection and cryoglobulinemia: Analysis of whole blood and plasma HCV-RNA concentrations and correlation with liver histology

The influence of cryoprecipitate (CP) on liver histology and peripheral tit ers of hepatitis C virus (HCV) RNA was evaluated for 115 patients with chro nic hepatitis. Fifty-four patients had measurable CP levels whereas 61 did not. Assessment of liver biopsies for grade of fibrosis revealed that patie nts with CP had increased fibrosis (P < .001) and incidence of cirrhosis (P = .001) compared with those without CP, In contrast, there was not a signi ficant difference in the-inflammatory activity score between the 2 groups. HCV RNA in whole blood (WB) and plasma (P1) groups was evaluated in patient s with or without CP by end-point-limiting dilution titer. Among patients w ith CP, WB titers were significantly higher than pi titers (P < .001); howe ver, there was no difference in WB or P1 titers in patients without CP (P = .068), Histological activity and fibrosis scores of patients from either g roup were compared with peripheral viral titers of WB and P1, percentage of CP, rheumatoid factor (RF) titer, and serum alanine transaminase (ALT). Th ere were significant correlations between the amount of fibrosis and the pe rcentage of CP and rheumatoid factor titer, yet neither of the latter param eters was correlated with inflammatory activity. These data suggest that pa tients with CP and chronic hepatitis owing to HCV are more likely to have p rogressive disease than patients without CP. Furthermore, the presence of C P in patients infected with HCV appears to influence the amount of virus de tected in patient P1, suggesting that WB assays may be more reliable for HC V-RNA quantitation in patients with CP.