TYPE II MIXED CRYOGLOBULINEMIA IN PATIENTS WITH HEPATITIS C VIRUS: TREATMENT WITH PEGYLATED-INTERFERON AND RIBAVIRIN

Introduction: Mixed Cryoglobulinemia is the most frequent extrahepatic disease in patients affected by Chronic Hepatitis C Virus infection. The association of pegylated-Interferon alpha-2a and Ribavirin could represent a rational and effective therapy for this extrahepatic disease. Was evaluated the safety and efficacy of pegylated-Interferon alpha-2a with Ribavirin for treatment of Hepatitis C Virus-related Mixed Cryoglobulinemia with detectable Hepatitis C Virus RNA, in patients with and without hepatic disease. Materials and methods: 24 patients (14 with chronic hepatitis, 2 with Child-Pugh Class A cirrhosis, and 8 without hepatic disease), affected by Hepatitis C Virus -related type II Mixed Cryoglobulinemia underwent treatment with standard dose of peg-Interferon alpha-2a 180 mcg once weekly with Ribavirin. Results: At the end of therapy, we observed a strict association between the eradication of hepatitis C virus and a complete clinical response (disappearance of cutaneous manifestations of cryoglobulinenzic vasculitis) with a complete virological and clinical response in 12/16 (75%) and 8/8 (100%) patients with and without hepatic disease, respectively. In the first group 8116 (50%) patients achieved a complete clinical response and sustained virological response, 4/16(25%) were non-responders and 4116 (25%) relapsers, while in the second group 7/8 (87.5%) patients achieved a complete clinical response and sustained virological response, and 118 (12.5%) was relapser. Therefore, we observed a higher rate of complete clinical response and sustained virological response (87.5% vs 50%) in patients without hepatic disease compared with patients with hepatic disease (p<0.01). Conclusion: Peg-Interferon alpha-2a with Ribavirin seems to be safe and useful for the treatment of Hepatitis C Virus-related type II Mixed Cryoglobulinemia not only in patients with but also without hepatic disease. Moreover, in our study seems that the antiviral therapy is more effective in patients affected by Hepatitis C Virus-related type II Mixed Cryoglobulinemia without hepatic involvement than in those with hepatic disease.