title: Cryoglobulinemia in chronic hepatitis C: clinical aspects and response to treatment with interferon alpha and ribavirin.
abstract: BACKGROUND
  The main extra-hepatic manifestation of hepatitis C is mixed cryoglobulinemia (MC). The aim of this study was to evaluate its prevalence among patients with chronic hepatitis C (CHC), to correlate its presence to host and virological variables and to the response to combined therapy with interferon-alpha and ribavirin.
  
  
  METHODS
  202 CHC naive patients (136 with chronic hepatitis and 66 with cirrhosis) were consecutively evaluated for the presence of cryoglobulins. Cryoprecipitates were characterized by immunoelectrophoresis and classified according to the Brouet's criteria.
  
  
  RESULTS
  The prevalence of MC was 27% (54/202), and 24% of them (13/54) showed major clinical manifestation of the disease. Even though type III MC was more frequent (78%), symptomatic MC was more common in type II MC. The presence of cirrhosis (RR=2.073; IC95%=1.029-4.179; p=0.041), and age of the patients (RR=1.035; IC95%=1.008-1.062; p=0.01) were independently associated with the presence of cryoglobulins. No relationship was found with viral load and genotype. 102 patients were treated with interferon alpha and ribavirin. Among these, 31 had MC. Sustained virological response (around 30%) was similar in patients with and without MC (p=0.971).
  
  
  CONCLUSIONS
  MC represents a prevalent complication in patients with CHC, specially older and cirrhotic patients. Only 24% of these patients show clinical manifestation of the disease, specially those with type II MC. The presence of MC did not affect the response to therapy.
authors.affiliation: Disciplina de Gastrenterologia da Universidade Federal de São Paulo, and Anatomia Patológica, Hospital Sírio-Libanes, São Paulo, SP, Brazil. parise@gastro.epm.br
authors.forename: Edison Roberto
authors.initials: ER
authors.lastname: Parise
authors.forename: Ana Cláudia
authors.initials: AC
authors.lastname: de Oliveira
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Ferraz
authors.forename: Aparecido Bernardo
authors.initials: AB
authors.lastname: Pereira
authors.forename: Kátia Ramos
authors.initials: KR
authors.lastname: Leite
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000188:drug therapy / Q000821:virology*; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012254:Ribavirin / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin