Effect of interferon alpha therapy on chronic hepatitis C patients with croglobulinemia (clinical & laboratory).

Background: Hepatitis C is a disease with significant global impact. Extrahepatic manifestations (EHM) are frequently noted in hepatitis C virus (HCV) patients. Cryoglobulinemia can be detected in 25 to 30% of the patients and is one of the most common disorders associated with HCV with a wide spectrum from mild purpura to life-threatening vasculitis. The most effective treatment of symptomatic HCV with mixed croglobulinemia (MC) is eradication of HCV infection. Objectives: To study the impact of interferon alpha (IFN-?) therapy on clinical and laboratory parameters in patients with HCV infection with and without cryoglobulin (CG) Patients and Methods: Extrahepatic manifestations and manifestations of CG as purpura, arthralgia, fatigue, renal, or neurological complications were detected & registered during the first & follow-up visits. CBC, kidney functions, as well as the followings before & after IFN-? therapy: liver functions (PT/INR, AST, ALT, s.albumin, total proteins, s. bilirubin) ESR, RF, quantitative PCR for HCV, s. CG, C4. The study included 100 HCV patients treated with peg-IFN plus ribavirin for 12 weeks regardless HCV genotype. Patients with other possible causes of CG were excluded. Results: Mean patients age:37.05?5.28 years, mean disease duration 10.8?2.5 years. The followings were observed: High prevalence of CG in chronic HCV patients (45% of patients).After Rx 13 CG +ve patients became -ve. (Complete responders (CR)): HCV RNA became undetectable at the end of 12th week).Unlike the partial responders (PR), there was statistical significant difference in CG before and after Rx in CR (<0.001*) , the median CG decreased from 99 to 52 pg/ml & the mean of C4 increased in CR (P< 0.001*). There was statistical significant difference between RF & ESR before and after Rx in CR and PR P <0.001* & 0.020*.There was +ve correlation between CG level & duration of infection, ALT, viral load and RF and a -ve one between CG & albumin levels, total proteins and C4. <0.001. Symptoms of mixed cryglobulinemia were present in both CG +ve and -ve patients except (peripheral neuropathy (PN) & nephropathy which occurred only in CG+ve patients. There was statistical significant difference between purpura, fatigue, arthralgia, arthritis and myalgia with RF (P< 0.05), & none between PN & nephropathy and RF (P> 0.05). IFN plus ribavirin were very effective in decreasing the viral load, improving liver functions, decreasing CG , RF, ESR & increasing C4 in CR more than PR. They were effective in the improvement of all CG symptoms except PN, nephropathy & fatigue. Conclusions: Cryoglobulin testing has been neglected in routine clinical laboratory by clinicians. Patients with manifestations suggestive of cryoglobulinemia should be tested for hepatitis C and conversely, signs and symptoms of this condition should be screened in patients with known HCV infection.