Hepatitis C virus chronic infection as a common cause of mixed cryoglobulinaemia and autoimmune liver disease

• DOI: 10.1111/j.1365-2796.1994.tb01116.x
• Publication Date: 2009-08-03T14:16:18Z
• Authors: C. FERRI; G. LONGOMBARDO; L. LA CIVITA; F. GRECO; F. LOMBARDINI; R. CECCHETTI; M. A. CAGIANELLI; S. MARCHI; M. MONTI; A. L. ZIGNEGO; M. P. MANNS
• Keywords: Male; Liver Diseases; Middle Aged; Hepatitis C; Autoimmune Diseases; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Cryoglobulinemia; Chronic Disease; Humans; Female; Aged

Abstract. Objectives. Mixed cryoglobulinaemia (MC) and autoimmune chronic hepatitis (AI‐CH) are frequently associated with hepatitis C virus (HCV) chronic infection. Because HCV represents a possible common aetiological factor, the aim of the present study is to investigate the clinico‐serological alterations of both MC and AI‐CH and to verify a possible overlap between these disorders.Setting. Patients from three tertiary referral centres.Subjects. Two Italian series of 88 MC patients and 30 AI‐CH type 1 were studied.Results. MC and AI‐CH share several clinico‐sero‐logical features. The patients' mean age (MC vs. AI‐CH: 60 ± 9 vs. 57 ± 13 years), disease duration (10.5 ± 5 vs. 9.6 ± 6 years), and female/male ratio (3.4 vs. 3.3) were very similar in the two series. Typical hallmarks of MC, i.e. purpura, arthralgias, and weakness, circulating mixed cryoglobulins with rheumatoid factor activity, and hypocomplement‐emia were also recorded in a significant number of AI‐CH patients. Similarly, chronic active hepatitis was found in 68% of MC patients and its histological and serological alterations were comparable with those of AI‐CH; moreover, amongst various auto‐antibodies, antinuclear antibodies and/or anti‐smooth‐muscle antibodies were detected in half of the cases of MC. Anti‐HCV antibodies, detected by second‐generation Chiron elisa and riba, were present in a high percentage of both MC and AI‐CH (94 vs. 80%), and frequently associated with HCV viraemia (86 vs. 77%). Finally, anti‐GOR, the HCV‐related autoantibodies, were found in half cases of MC and AI‐CH.Conclusions. On the whole, these data suggest that HCV in combination with other infectious and environmental and genetic factors can trigger a complex immunological disorder with different clinical patterns.