title: Mixed cryoglobulinemia is associated with increased risk for death, or neoplasia in HIV-1 infection.
abstract: BACKGROUND
  Cryoglobulinemia has been reported in several chronic infectious and autoimmune diseases, and in patients with HIV-1 infection. Cryoglobulinemia associated with hepatitis C virus infection is considered a risk factor for the development of neoplasia, especially B-cell non-Hodgkin lymphoma. This study was undertaken to investigate whether the presence of circulating cryoglobulins is associated with survival or development of neoplastic disease in HIV-1 infection.
  
  
  METHODS
  We evaluated 87 unselected consecutive HIV-1 infected patients for the presence of cryoglobulinemia and they were prospectively followed up for a median of 34 months, with clinic visits at 4-month intervals. None of the patients had neoplasia at study entry. Time-to-event analysis for death, neoplasm and B-cell lymphoproliferative disorder were performed with Cox proportional hazards models.
  
  
  RESULTS
  Mixed cryoglobulinemia (types II and III) was detected in 24 (28%) of the 87 patients. During the follow up, 12 patients died and 8 developed neoplastic disease. Multivariate analysis showed that circulating cryoglobulins were an independent predictor of death [relative risk (RR), 4.97; 95% confidence intervals (CI), 1.26-19.63] and development of neoplasia (RR, 5.18; 95% CI, 1.23-21.83). In addition, cryoglobulinemia reached borderline significance as a predictor of lymphoproliferative disorder of B-cell origin (P = 0.08; RR, 4.53; 95% CI, 0.83-24.75).
  
  
  CONCLUSIONS
  Our results suggest that cryoglobulinemia is associated with an increased risk for death, neoplasia or development of lymphoproliferative disorder of B-cell origin, in HIV-1 infected patients.
authors.affiliation: Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece. tkordoss@med.uoa.gr
authors.forename: T
authors.initials: T
authors.lastname: Kordossis
authors.forename: N V
authors.initials: NV
authors.lastname: Sipsas
authors.forename: A
authors.initials: A
authors.lastname: Kontos
authors.forename: U
authors.initials: U
authors.lastname: Dafni
authors.forename: H M
authors.initials: HM
authors.lastname: Moutsopoulos
mesh_terms: D000328:Adult; D003449:Cryoglobulinemia / Q000401:mortality* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality* / Q000821:virology; D015497:HIV-1; D006801:Humans; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000821:virology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis