title: Telbivudine in the treatment of hepatitis B-associated cryoglobulinemia.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is often associated to extrahepatic manifestations while these are less common in HBV infections. Reported cases of mixed cryoglobulinemia (MC) related to HBV infection are very rare: the exact prevalence of this extrahepatic manifestation has not yet been established and the optimal treatment is unclear (no guideline indications are available).
  
  
  OBJECTIVE
  We propose an explorative evaluation of treatment of MC HBV-related with telbivudine (LdT) in a small group of patients affected by chronic hepatitis B (CHB).
  
  
  METHODS
  We included 7 patients affected by CHB naive for previous treatment. We administered a single dose of 600mg/day of LdT. ALT levels, HBV-DNA, CD4+/CD8+ ratio and cryocrit were monthly measured. We evaluated the efficacy of 1 year-treatment with LdT on the cryocrit and MC-related symptoms.
  
  
  RESULTS
  We observed a significant decrease of cryocrit (p=0.002) and HBV-DNA (p=0.001) during the treatment; CD4+/CD8+ ratio increased (p=0.002) after 1 year. Five patients did not show symptoms and two patients with necrotizing vasculitis have reported a significant clinical improvement with only residual paresthesias. No exacerbations were observed.
  
  
  CONCLUSIONS
  We consider LdT a suitable option for the treatment of MC HBV-related.
authors.affiliation: Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Boglione
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Avolio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cariti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage*; D016516:CD4-CD8 Ratio; D003449:Cryoglobulinemia / Q000175:diagnosis*; D003450:Cryoglobulins / Q000032:analysis; D004279:DNA, Viral / Q000097:blood; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077712:Telbivudine; D013936:Thymidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D003450:Cryoglobulins; D004279:DNA, Viral; D000077712:Telbivudine; D000410:Alanine Transaminase; D013936:Thymidine