Article Text

PDF
AB1150 Effect of Interferon Alpha Therapy on Chronic Hepatitis C Patients with Croglobulinaemia (Clinical & Laboratory)
  1. N. Mohannad1,
  2. R. Kader2
  1. 1Alexandria University hospitals, Internal Medicine Department, Rheumatology Unit
  2. 2Internal Medicine, Rheumatology Unit, Faculty of Medicine Alexandria University, Alexandria, Egypt

Abstract

Background Hepatitis C is a disease with significant global impact.Extrahepatic manifestations (EHM) are frequently noted in HCV patients (pts). Cryoglobulinemia can be detected in 25 to 30% of the pts & is one of the most common disorders associated with HCV with a wide spectrum from mild purpura to life-threatening vasculitis.The most effective treatment (Rx) of symptomatic HCV MC is eradication of HCV infection.

Objectives To study the impact of interferon alpha (IFN-α) therapy on clinical and laboratory parameters in pts with HCV infection with & without cryoglobulin (CG)

Methods EHM & manifestations of CG as purpura, arthralgia, fatigue, renal,nor neurological complications were detected & registered during the first & follow-up visits. CBC, kidney functions, as well as the followings before & after IFN-α therapy: liver functions (PT/INR, AST, ALT, s. albumin, total proteins, s. bilirubin) ESR, RF, quantitative PCR for HCV, s. CG, C4.The study included 100 HCV pts treated with peg-IFN plus ribavirin for 12 weeks regardless HCV genotype. Pts with other possible cause of CG were excluded

Results Mean pts age:37.05±5.28 ys, mean disease duration 10.8±2.5 ys.The followings were observed: High prevalence of CG in chronic HCV pts (45% of patients). After Rx 13 CG +ve pts became -ve. (Complete responders (CR): HCV RNA became undetectable at the end of 12th week).Unlike the partial responders (PR), there was statistical significant difference in CG before and after Rx in CR (<0.001*), the median CG decreased from 99 to 52 pg/ml & the mean of C4 increased in CR (P<0.001*). There was statistical significant difference between RF & ESR before and after Rx in CR and PR P<0.001* & 0.020*. There was +ve correlation between CG level & duration of infection, ALT, viral load and RF and a -ve one between CG & albumin levels, total proteins and C4. <0.001. Symptoms of mixed cryglobulinemia were present in both CG +ve and -ve pts except PN & nephropathy which occurred only in CG+ve pts (table). There was statistical significant difference between purpura, fatigue, arthralgia, arthritis and myalgia with RF (P<0.05), & none between PN & nephropathy and RF (P>0.05). IFN plus ribavirin were very effective in decreasing the viral load, improving liver functions, decreasing CG, RF, ESR & increasing C4 in CR more than PR. They were effective in the improvement of all CG symptoms except PN, nephropathy & fatigue.

Conclusions CG testing has been neglected in routine clinical laboratory by clinicians

Patients with manifestations suggestive of cryoglobulinemia should be tested for hepatitis C and conversely, signs and symptoms of this condition should be screened in patients with known HCV infection.

References

  1. Ferri C, et al.: Current treatment of hepatitis C-associated rheumatic diseases. Arthritis Res Ther 2012; 14:215.

Disclosure of Interest None declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.