Keywords
HCV; Vertical Transmission; Anti-HCV Antibodies; HCV-RNA; United Arab Emirates
Abstract
Chronic Hepatitis C Virus (HCV) is a worldwide public health problem affecting over 170 million people, or about 3% of the world’s population. In Egypt, the situation is quite worse, with the overall prevalence (percentage of people) positive for antibody to HCV being 14.7% [1].
HCV predominantly affects the liver but it can also produce a number of extra hepatic manifestations. It has been reported that 74% of patients with hepatitis C have at least one extra hepatic manifestation, the most common conditions including essential mixed cryoglobulinemia (40%), arthralgia or joint pain (23%), paresthesia (17%), myalgia (15%), pruritus (15%), and sicca syndrome (11%) [2].
Cryoglobulinemia is a blood disorder caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is cooled and then dissolve again when rewarded. These proteins can be deposited in small and medium-sized blood vessels, which can lead to restricted blood flow to joints, muscles, and organs. There are three types of cryoglobulinemia (types I, II and III); types II and III have rheumatoid factor activity whereas type I does not (Table 1). The most common and severe form Is Mixed Cryoglobulinemia (MC), a systemic vacuities involving small and medium-sized arteries and veins. MC is characterized by the deposition of immune complexes containing mainly rheumatoid factor, IgG, HCV RNA, and complement on endothelial surfaces, resulting in vascular inflammation, albeit through poorly understood mechanisms. Moreover, HCV can trigger impairment in lymph proliferation with cryoglobulin production [3].
The syndrome of mixed cryoglobulinemia represents the consequence of an immune complex type vasculitis, characterized by the clinical triad of purpura, arthralgia, and asthenia, and may involve numerous organs, particularly the peripheral nervous system and the kidneys [4].
In a large prospective study of 1614 patients chronically infected with HCV, mixed cryoglobulinemia was the predominant extra-hepatic biologic manifestation, identified in 40% of patients. Using multivariate analysis, four independent factors were found to be significantly associated with the presence of cryoglobulins: female sex, alcohol consumption more than 50 g/d, HCV genotype II or III, and extensive liver fibrosis. Cryoglobulin-positive patients were examined for arthralgias, arterial hypertension, purpura, and systemic vasculitis. Considering the high frequency of positive cryoglobulins in patients with HCV, severely symptomatic mixed cryoglobulinemia with vasculitis was rare, noted in only 2 to 3% of cryoglobulin-positive patients [3,5].
Citation
El-Bendary M, Elalfy H, Sobh H and Neamatallah M. Mixed Cryoglobulinemia and HCV: An Overview. SM J Hepat Res Treat. 2015; 1(1): 1005 https://dx.doi.org/10.36876/smjhrt.1005