Hepatitis B virus related cryoglobulinemic vasculitis: A multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie - GISC

Background: Cryoglobulinemic vasculitis (CV) related to Hepatitis-B Virus (HBV) is rare and its treatmentis ill-defined.Aims: To describe clinical and treatment characteristics of HBV-related CV patients. In addition, the effi-cacy of treatment with antiviral agent nucleotide (NUC), including Entecavir, Adefovir, and Lamivudine,was explored.Methods: In four Italian centres, 17 HBV-positive CV patients (median age 56 years, range 45–70) wereenrolled.Results: The extrahepatic manifestations were: purpura (100%), arthralgias (71%), peripheral neuropathy(29%), chronic hepatitis (47%), liver cirrhosis (29%), and glomerulonephritis (18%). Mixed cryoglobuline-mias were type II (88%) and type III (12%). The median cryocrit was 3% (range 1–14), rheumatoid factor was200 U/L (range 20–5850), C4 was 12 mg/dl (range 2–31), ALT 71 U/L (range 36–114). All patients wereHBsAg-positive and 80% anti-HbeAg-positive. At enrollment, they were treated with steroids (eight),Entecavir (five), Alpha-IFN (two), Adefovir and Lamivudine (one each). After NUC treatment, no diseaseprogression was observed and, in all patients, HBV-DNA became undetectable. Moreover, a regressionof purpura and a reduction of cryocrit were observed. Four patients died during therapy, two of kidneyfailure and two of liver cirrhosis.Conclusion: NUC therapy appeared to be safe and effective in CV-related HBV.