title: Cryoglobulinemia vasculitis: how to handle.
abstract: More than 50% of hepatitis C virus (HCV) infected patients produce a mixed cryoglobulin and two-third of them will develop a symptomatic cryoglobulinemia vasculitis (CryoVas). In the present review, we aim at summarizing the most recent advances in diagnosis and treatment of HCV-CryoVas.
  
  
  
  The treatment of HCV-CryoVas has much changed during the last months. The recent emergence of new direct-acting (DAA) interferon (IFN)-free antivirals, enabling high cure rates with a very good safety profile now permit to cure most patients with HCV-CryoVas. Multidisciplinary consensus recommends to consider IFN-free DAAs as first-line treatment for HCV-CryoVas patients. Immunosuppressive treatments (i.e. rituximab, glucocorticosteroids, cyclophosphamide and plasmapheresis) remain an interesting therapeutic approach, in severe form of HCV-CryoVas, failure or contradiction to antiviral treatments.
  
  
  
  The great efficacy of DAA on HCV-CryoVas represents a major advance in clinical practice, as these new antivirals provide for the first time a well tolerated and definite treatment of such complication for most patients.
authors.affiliation: aSorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B) bINSERM, UMR_S 959 cCNRS, FRE3632 dAP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Desbois
authors.forename: Cloe
authors.initials: C
authors.lastname: Comarmond
authors.forename: David
authors.initials: D
authors.lastname: Saadoun
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000209:etiology / Q000628:therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D010956:Plasmapheresis / Q000379:methods*; D000069283:Rituximab / Q000627:therapeutic use; D014657:Vasculitis / Q000209:etiology / Q000628:therapy*
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide