Hepatitis B virus related cryoglobulinemic vasculitis: A multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie - GISC.
BACKGROUND
Cryoglobulinemic vasculitis (CV) related to Hepatitis-B Virus (HBV) is rare and its treatment is ill-defined.


OBJECTIVE
To describe clinical and treatment characteristics of HBV-related CV patients. In addition, the efficacy of treatment with antiviral agent nucleotide (NUC), including Entecavir, Adefovir, and Lamivudine, was explored.


METHODS
In four Italian centres, 17 HBV-positive CV patients (median age 56 years, range 45-70) were enrolled.


RESULTS
The extrahepatic manifestations were: purpura (100%), arthralgias (71%), peripheral neuropathy (29%), chronic hepatitis (47%), liver cirrhosis (29%), and glomerulonephritis (18%). Mixed cryoglobulinemias were type II (88%) and type III (12%). The median cryocrit was 3% (range 1-14), rheumatoid factor was 200U/L (range 20-5850), C4 was 12mg/dl (range 2-31), ALT 71U/L (range 36-114). All patients were HBsAg-positive and 80% anti-HbeAg-positive. At enrollment, they were treated with steroids (eight), Entecavir (five), Alpha-IFN (two), Adefovir and Lamivudine (one each). After NUC treatment, no disease progression was observed and, in all patients, HBV-DNA became undetectable. Moreover, a regression of purpura and a reduction of cryocrit were observed. Four patients died during therapy, two of kidney failure and two of liver cirrhosis.


CONCLUSIONS
NUC therapy appeared to be safe and effective in CV-related HBV.
Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy. Electronic address: cesare.mazzaro@gmail.com.
Cesare
C
Mazzaro
Epidemiology and Biostatistics Unit, CRO-Aviano National Cancer Institute, Aviano, Italy. Electronic address: epidemiology@cro.it.
Luigino
L
Dal Maso
Centro Manifestazioni Sistemiche da Virus Epatitici, University of Florence, Firenze, Italy.
Teresa
T
Urraro
Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy.
Endri
E
Mauro
Department of Internal Medicine, Saronno General Hospital, Saronno (VA), Italy.
Laura
L
Castelnovo
Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy.
Pietro
P
Casarin
Department of Internal Medicine, Saronno General Hospital, Saronno (VA), Italy.
Giuseppe
G
Monti
Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy.
Valter
V
Gattei
Centro Manifestazioni Sistemiche da Virus Epatitici, University of Florence, Firenze, Italy.
Anna Linda
AL
Zignego
Department of Medical and Surgical Sciences, University of Trieste, Trieste, Italy.
Gabriele
G
Pozzato
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus; D006801:Humans; D007558:Italy; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D016896:Treatment Outcome; D014657:Vasculitis / Q000188:drug therapy* / Q000209:etiology
D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000225:Adenine
Cryoglobulinemia; Entecavir; Hepatitis B virus; Vasculitis