A clinical and virological study of hepatitis C virus-related cryoglobulinemia in Germany

• Published in: Journal of hepatology 1998-09, Vol.29 (3), p.375-384
• Main Authors: Weiner, Stefan M., Berg, Thomas, Berthold, Hans, Weber, Sabine, Peters, Thomas, Blum, Hubert E., Hopf, Uwe, Peter, Hans Hartmut
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Agglutinins - blood; AIDS/HIV; Biological and medical sciences; Biomarkers - blood; Blood Viscosity; Chronic liver disease; Complement C3d - analysis; Cryoglobulinemia; Cryoglobulinemia - epidemiology; Cryoglobulinemia - virology; Cryoglobulins; Female; Genotype; Germany - epidemiology; Hepacivirus - isolation & purification; Hepatis C virus; Hepatitis C - complications; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Prevalence; Rheumatoid Factor - blood; Viral diseases; Viral hepatitis; Viral Load
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(98)80054-8

Background/Aims: Several reports, especially from Southern Europe, have demonstrated a close association between hepatitis C virus (HCV) infection and mixed cryoglobulinemia. In this study we have analyzed the significance of HCV-related cryoglobulinemia in Germany. Methods: Sera from 79 patients with cryoglobulinemia of type I ( n=21), II ( n=28) or III ( n=30) were investigated for HCV markers. Furthermore, 132 consecutive patients with chronic hepatitis C were studied for the presence of cryoglobulins. Genotypes of HCV were determined according to Simmonds, and HCV-RNA concentrations were measured in patients with and without cryoglobulinemia. Results: In 79 patients with cryoglobulinemia we found anti-HCV antibodies in 17 (22%) and HCV-RNA in 11 patients (14%). HCV antibodies were more frequent in essential (44%) compared to secondary mixed cryoglobulinemia (15%). In 132 patients with chronic HCV infection cryoglobulins were detected in 37 patients (28%), in 21 of them at low levels. Clinical symptoms due to cryoglobulinemia were observed in eight of the 37 patients, severe vasculitis in three patients with high cryocrit-levels and cryoprecipitation at room temperature. HCV genotype 1 and subtype 1b were most prevalent, both in patients with and without cryoglobulinemia, and mean HCV-RNA levels were not different between the two groups. Comparison of HCV-RNA levels in cryoprecipitates, supernatant and native serum suggests binding of HCV-RNA to the cryoprecipitate with different affinity in individual patients. Conclusion: The lower prevalence of HCV-related cryoglobulinemia in our study compared with data from Italy and France suggests a south-north gradient in the prevalence of HCV-associated cryoglobulinemia in Europe.