Mixed cryoglobulinemia in chronic hepatitis C: transformation of perceptions in the context of modern antiviral therapy

Abstract

Mixed cryoglobulinemia is the most frequent extrahepatic manifestation of chronic hepatitis C virus, which develops as a result of progressive lymphoproliferative disorders induced by the virus persistent stimulation of immunocompetent cells, primarily, B-lymphocytes. Lymphoproliferation clinical manifestations involve B-cell non-Hodgkin lymphoma and cryoglobulinemic vasculitis, in the pathogenesis of which there are also elements of autoimmunity activation. Antiviral therapy with direct-acting agents enables hepatitis C elimination in almost all treated patients. With a sustainable virologic response, most patients develop a complete or partial cryoglobulinemic vasculitis remission, sometimes without any concomitant immunosuppressive treatment. Cryoglobulin production is occasionally suppressed. Less frequently, such disease associated immunological signs as an increased level of rheumatoid factor and a reduced concentration of complement C4 are normalized. The review covers pathogenesis, clinical manifestations, general principles and outcomes of lymphoproliferative disorders therapy, in particular, the treatment of cryoglobulinemic vasculitis, associated with chronic HCV infection in the era of modern antiviral therapy. Additionally, the review hypothesizes possible consequences of persistent cryoglobulinemia after the successful management of chronic HCV.

Keywords:chronic hepatitis C; lymphoproliferation; mixed cryoglobulinemia; B-cell non-Hodgkin lymphoma; antiviral therapy; immunosuppressive therapy

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflict of interest.

Contribution. Сoncept and design – Zubkin M.L., Semenenko T.A., Kryukov E.V.; text writing – Semenenko T.A., Zubkin M.L., Chervinko V.I., Frolova N.F., Konopleva N.V., Kryukov E.V.; approval of the final version of the article – Zubkin M.L., Semenenko T.A., Kryukov E.V.; responsibility for the integrity of all parts of the article – Zubkin M.L., Chervinko V.I., Kryukov E.V.

For citation: Zubkin M.L., Semenenko T.A., Chervinko V.I., Frolova N.F., Konopleva N.V., Kryukov E.V. Mixed cryoglobulinemia in chronic hepatitis C: transformation of perceptions in the context of modern antiviral therapy. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (3): 138–50. DOI: https://doi.org/10.33029/2305-3496-2022-11-3-138-150

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CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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