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2013 ; 92
(5
): 245-256
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Impact of Cryoglobulinemic Syndrome on the Outcome of Chronic Hepatitis C Virus
Infection: A 15-Year Prospective Study
#MMPMID23982056
Lauletta G
; Russi S
; Conteduca V
; Sansonno L
; Dammacco F
; Sansonno D
Medicine (Baltimore)
2013[Sep]; 92
(5
): 245-256
PMID23982056
show ga
We evaluated the influence of cryoglobulinemic syndrome (CS) on the outcome of
chronic hepatitis C virus (HCV) infection in a 15-year prospective study. We
assessed a cohort of 950 chronically HCV-infected patients, collected from the
beginning of 1990 to the end of 2010. All patients had received a liver
histologic diagnosis. Mixed cryoglobulinemia (MC) was determined in 246 patients
(25.8%), of whom 184 also had CS. They were assessed every 3 months for 15 years,
at least; 141 patients with CS and 601 without MC completed the study.No
spontaneous clearance of cryoglobulins was noted. Type II to type III spontaneous
switching was ascertained in 1.6% (0.08%/yr) patients. The estimated progression
rate of liver fibrosis was lower in CS(+) than in MC(-) patients (p < 0.05). The
15-year cumulative probability of developing cirrhosis and/or hepatocellular
carcinoma was higher in MC(-) than in CS(+) patients (24.9% vs. 14.2%, p < 0.005
and 20.3% vs. 7.5%, p = 0.003, respectively). Renal insufficiency, neurologic
impairment, or B-cell non-Hodgkin lymphoma were significantly more frequent in
CS(+) than in MC(-) patients (32.6% vs. 3%, p < 0.0001; 31.2% vs. 4.8%, p <
0.0001; and 15% vs. 7.1%, p = 0.003, respectively). However, in spite of
different morbidity features and causes of death, the 15-year survival rate was
similar in the 2 groups (70.2% vs. 71.7%). Antiviral therapy had an undisputable
impact on patient outcome.This 15-year prospective cohort study shows that,
although CS has no influence on the overall survival of HCV-infected patients, it
significantly modifies the natural history of chronically HCV-infected patients.