Cryoglobulinaemia vasculitis in patients coinfected with HIV and hepatitis C virus.
OBJECTIVE
To describe mixed cryoglobulinaemia (MC) vasculitis in patients coinfected with hepatitis C virus (HCV) and HIV.


METHODS
Retrospective multicentre study through the GERMIVIC Database of 4005 HIV/HCV-coinfected patients.


METHODS
The characteristics and outcome of 11 HIV/HCV-coinfected patients with MC vasculitis were analysed and compared with those of 118 HCV-infected patients with MC vasculitis.


RESULTS
The mean age was 46 years (SD, 14), with 82% male. The median initial CD4 cell count was 367 cells/microl (range, 252-846). After a mean follow-up of 44.4 months, two deaths (18%) were noted. Clinical manifestations of MC included polyneuropathy in seven (64%), purpura in four (36%), arthralgia in four (36%), and kidney involvement in three (27%). Six patients received combination treatment with interferon-alfa and ribavirin, three of whom had sustained HCV virological response and were complete clinical responders. Four patients received corticosteroids and two showed a partial clinical response. Regardless of the HIV virological response, antiretroviral therapy did not improve MC vasculitis. Compared with patients with HCV monoinfection, coinfected patients were younger (P < 0.001), more frequently male (P = 0.03), more frequently intravenous drug users (P < 0.001), had higher HCV viraemia (P = 0.004), higher liver necroinflammation (P = 0.03), higher gammaglobulinaemia (P < 0.001) and lower cryoglobulin level (P = 0.03). The clinical manifestations of MC vasculitis did not differ significantly between the two groups.


CONCLUSIONS
There was a beneficial effect of anti-HCV therapy for HIV/HCV-coinfected patients with MC vasculitis.
Service de Médecine Interne, Hôpital La Pitié-Salpêtrière, Paris, France.
David
D
Saadoun
Laurent
L
Aaron
Mathieu
M
Resche-Rigon
Gilles
G
Pialoux
Jean-Charles
JC
Piette
Patrice
P
Cacoub
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003449:Cryoglobulinemia / Q000276:immunology / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014657:Vasculitis / Q000276:immunology / Q000821:virology*; D019562:Viral Load
D000998:Antiviral Agents; D012367:RNA, Viral