Relationship Between Cryoglobulinemia-associated Nephritis and HCV Infection

Dario Roccatello; Osvaldo Giachino; Elisa Menegatti; Simone Baldovino

Disclosures

Expert Rev Clin Immunol. 2008;4(4):515-524. 

In This Article

Expert Commentary

Milder forms of cryoglobulinemia can be managed using combined antiviral therapy. In these cases, IFN-α can produce a significant clinical improvement, especially in combination with ribavirin, even though a substantial proportion of patients relapse. Further progresses can be expected by the widespread use of peg-IFN-α. Besides, current therapeutic strategies for HCV eradication could usefully be based on favorable experiences in treatment of chronic hepatitis. Genotype 1 calls for a 48-week course of therapy with weekly injections of either peg-IFN-α2a or -α2b and oral ribavirin daily. Patients infected with genotypes 2 and 3 could often be treated for a shorter duration (24 weeks).

Immunosuppression is still regarded as the first-line intervention if the renal involvement is severe or during acute immunological flare-ups. Steroids plus cyclophosphamide represents the most popular combination therapy. The less toxic mycophenolate mofetil is an alternative immunosuppressive tool. Plasma exchange, especially double-filtration plasmapheresis, continues to be successfully used in escalation protocols.

Rituximab has gained a definite role in the more severe cases, characterized by worsening of renal function, sensory motor neuropathy, extensive skin ulcers and distal necrosis. Persistance of effects appears finite with mean response durations lasting 6-12 months. The '4-plus-2' protocol seems to favor a longer-lasting response.

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