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 CVirus infection. The association of pegylated-Interferon alpha-2a and Ribavirin could represent a rational and effective therapy for thisextrahepatic disease. Was evaluated the safety and efficacy of pegylated-Interferon alpha-2a with Ribavirin for treatment of HepatitisC 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 hepaticdisease), affected by Hepatitis C Virus -related type II Mixed Cryoglobulinemia underwent treatment with standard dose of pegInterferonalpha-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 clinicalresponse (disappearance of cutaneous manifestations of cryoglobulinemic vasculitis) with a complete virological and clinicalresponse in 12/16 (75%) and 8/8 (100%) patients with and without hepatic disease, respectively. In the first group 8/16 (50%)patients achieved a complete clinical response and sustained virological response, 4/16 (25%) were non-responders and 4/16 (25%)relapsers, while in the second group 7/8 (87.5%) patients achieved a complete clinical response and sustained virological response,and 1/8 (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-relatedtype II Mixed Cryoglobulinemia not only in patients with but also without hepatic disease. Moreover, in our study seems that the antiviraltherapy is more effective in patients affected by Hepatitis C Virus-related type II Mixed Cryoglobulinemia without hepatic involvementthan in those with hepatic disease.