Mixed cryoglobulinemia in hepatitis C patients

Cryoglobulins are immunoglobulins that persist in the serum, precipitate wi th cold temperature and resolubilize when rewarmed. Types II and III are mi xed cryoglobulins (MC), composed of different immunoglobulins, with a monoc lonal component in type II and only polyclonal immunoglobulins in type UI. Mixed cryoglobulins are associated with connective-tissue disease, malignan t hematological disorder (type B lymphoproliferation) or obvious infectious process. Mixed cryoglobulinemia syndrome is characterized by the clinical tried of purpura, arthralgia and asthenia associated with type II or type I II MC. The disorder is the consequence of an immune-complex-type vasculitis as supported by clinical features, analysis of the cryoglobulins, the usua lly depressed level of complement during the active phase of the disease, a nd the deposition of immunoglobulins and complement in the lesions. Such cr yoglobulinemia vasculitis may involve numerous organs, particularly the per ipheral nervous system and the kidneys. MC is frequently associated with cl inical and biological evidence of liver disease. There has been some contro versy about which comes first, MC or chronic Liver disease, but it seems fa irly clear that MC is often a manifestation of underlying chronic active or persistent hepatitis. In MC patients, the hepatotropic antigen(s) capable of triggering production of antibodies which can later form immune complexe s has been sought for many Sears. In the Last ten S-ears, numerous studies have demonstrated that infection with hepatitis C virus is involved in the pathogenesis of most mired cryoglobulinemia. This review analyzes the main published data on hepatitis C virus-mixed cryoglobulinemia, the role of lif er alterations, the predictive factors associated with NC production in HCV patients and its symptomatic nature or not, and the different types of vas culitis associated with HCV chronic infection.