Minerva Gastroenterology 2021 Apr 01

DOI: 10.23736/S2724-5985.21.02848-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Impact of direct acting antivirals on hepatitis c virus-related cryoglobulinemic syndrome

Anna L. ZIGNEGO ✉, Silvia MARRI, Laura GRAGNANI

MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, Center for Research and Innovation CRIAMASVE, University of Florence, Firenze, Italy

INTRODUCTION: Mixed cryoglobulinemia (MC) is a B-cell lymphoproliferative disorder largely attributable to HCV infection. MC clinical manifestations are determined by systemic vasculitis of low/medium sized vessels (mixed cryoglobulinemia syndrome or cryoglobulinemic vasculitis and CV) caused by the deposition of cryoglobulins in blood vessels.
EVIDENCE ACQUISITION: A systematic review was performed via the Medline and Scopus databases to evaluate studies concerning CV treatment with new direct antiviral agents (DAAs) and their effect on the syndrome.
EVIDENCE SYNTHESIS: The introduction of Interferon-free protocols has led to more evident positive effects than those observed in the treatment of C hepatitis/cirrhosis. In fact, IFN-free, DAA-based therapy minimised side effects permitting the treatment of previously contraindicated patients and led to a particularly high SVR rate and to a clinical/immunological response in the majority of patients, even if at different levels in different patients, from restitutio ad integrum to partial response. In view of the clearly positive evolution in CV management, the persistence of CV manifestations, in partial or non-responders continues to pose problems in the clinical approach to patients who represent a new condition that is still not completely known.
CONCLUSIONS: Results of DAAs-based therapy strongly confirm the use of anti-HCV therapy as the first-line therapeutic option in CV patients. However, growing evidence of a possible persistence or late relapse of CV suggests the need for longer/more accurate post-DAAs follow-ups as well as biomarkers that are capable of predicting the risk of clinical relapse/persistence to allow for the design of rational post-HCV eradication clinical flow-charts.

KEY WORDS: Hepatitis C virus; Mixed cryoglobulinemia; Cryoglobulinemic syndrome; Cryoglobulinemic vasculitis; Direct acting antivirals