INTERFERON-ALPHA TREATMENT OF HEPATITIS-C VIRUS-ASSOCIATED MIXED CRYOGLOBULINEMIA

Background/Aims: Chronic hepatitis C virus infection is frequently ass ociated with mixed cryoglobulinemia. The efficacy of interferon-alpha treatment in the presence of cryoglobulinemia, particularly the rate o f sustained responders, has not yet been well defined. Methods: Fifty- nine consecutive patients with chronic HCV infection were studied pros pectively with regard to the presence of cryoglobulinemia and their bi ochemical and virological response to interferon-alpha(2a) therapy. Re sults: Cryoglobulins mere detected in sera of 23 patients, For this la tter group of patients, significant differences were found compared to the 36 patients without cryoglobulinemia, i.e. the prevalence of fema le sex was higher, the duration of liver disease was longer and distin ctive laboratory abnormalities, e.g. higher rheumatoid factor activity were noted as well as a higher prevalence of cirrhosis. The distribut ion of HCV genotypes and serum HCV RNA titers was similar in the two g roups. Interferon-alpha treatment regimens were not different regardin g mean cumulative dose and mean duration of therapy. The response to t herapy was almost identical, i.e. 35% of patients with cryoglobulnenmi a showed a sustained response compared to 22% of patients without cryo globulinemia. The percentages of patients showing a relapse or breakth rough mere similar in both groups. Pre-treatment viremia levels mere h igher in non-responders compared to sustained responders. Non-responde rs appeared to be more frequent among patients infected with genotypes 1a and 1b, especially among male patients without cryoglobulinemia. C onclusions: The presence of cryoglobulinemia per se in chronic HCV-inf ected patients does not adversely affect the outcome of interferon-alp ha therapy, including the rate of sustained response.