Clinical

Anti-HCV treatment effective for vasculitis in HIV/HCV coinfected patients

Last Updated: 2006-05-29 11:30:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Anti-hepatitis C virus (HCV) therapy can benefit patients with mixed cryoglobulinemia vasculitis who are coinfected with HCV and HIV, a new study shows.

The study found no difference in the clinical manifestations of mixed cryoglobulinemia vasculitis between patients with HCV and HIV and HCV alone, while the findings do suggest that cellular immunity may play a role in the pathogenesis of mixed cryoglobulinemia vasculitis in patients with HIV, Dr. David Saadoun of the Hopital La Pitie-Salpetriere in Paris and colleagues report.

Sixty to 80% of mixed cryoglobulinemia vasculitis cases occur in patients infected with HCV, Dr. Saadoun and his team point out. While 17-26% of patients with HIV have detectable levels of cryoglobulins, mixed cryoglobulinemia vasculitis is rare in HIV-positive patients, and it remains unclear whether HIV infection may cause the condition.

To investigate, Dr. Saadoun and his team compared 11 patients with HIV/HCV and mixed cryoglobulinemia vasculitis to 118 patients with mixed cryoglobulinemia vasculitis and HCV who were not co-infected with HIV. HCV/HIV co-infected patients had higher HCV levels (6.1 log copies/ml vs. 5.6 log copies/ml), worse liver inflammation (Metavir activity score 1.87 vs. 1.14), and lower levels of gammaglobulins (25.6 g/l vs. 12.1 g/l). They were also more likely to be male and to use drugs intravenously, and were younger on average.

Treatment of HCV in co-infected patients was effective, with clearance of the virus linked to resolution of mixed cryoglobulinemia vasculitis symptoms, the researchers found. Three patients who had a sustained HCV virological response showed a complete clinical response, as did a patient whose HCV viral load was reduced by more than 2 log copies/ml. One patient had a complete clinical and virological response, but experienced a reappearance of HCV viremia that coincided with a mixed cryoglobulinemia relapse.

All of the HIV/HCV coinfected patients had CD4 T cell counts above 250 cells/microliter when they were diagnosed with mixed cryoglobulinemia vasculitis. The researchers found no association between improvements in HIV viremia and clinical symptoms of mixed cryoglobulinemia vasculitis.

"The role of cellular immunity in the pathogenesis of mixed cryoglobulinemia vasculitis is supported by an initial CD4 cell count greater than 250 cells/microliter in all coinfected patients. Taken together, these data suggest an indirect role for HIV itself in mixed cryoglobulinemia vasculitis in patients coinfected with HIV and HCV," the researchers conclude.

AIDS 2006;20:871-877.