Benefit of direct-acting antiviral therapy for hepatitis C virus (HCV) in monoinfected and HIV-HCV-coinfected patients with mixed cryoglobulinaemia.

OBJECTIVES: Mixed cryoglobulinaemia (MC) is found in 40-60% of patients with chronic hepatitis C virus (HCV) infection. Direct-acting antiviral (DAA) regimens considerably improve clinical outcome of HCV infection with sustained virological response rates (SVR) above 90%. We aimed to evaluate the impact of DAA therapy on cryoglobulin clearance and on MC-related symptoms in patients with HCV-associated MC.

METHODS: Thirty-five HCV-monoinfected and 12 HIV-HCV-coinfected patients with symptomatic or asymptomatic MC treated with DAA regimen were analysed. Cryoglobulin levels were assessed at DAA initiation, at different time points during treatment and after treatment and until cryoglobulin clearance if any.

RESULTS: Median age was 61 years and 51% (24/47) were males. HIV patients had all undetectable HIV RNA with combined antiretroviral therapy. MC was symptomatic in 77% (27/35) of HCV-monoinfected patients and in 8% (1/12) of HIV-HCV-coinfected patients (p < 0.001). Fifty-one per cent (24/47) of patients were previous non-responders to pegylated-interferon/ribavirin (PEG-IFN/RBV) therapy and 32% (15/47) were cirrhotics. One patient received DAA + PEG-IFN/RBV and all others received an IFN-free DAA regimen. The overall SVR12 rate was 100%. Cryoglobulinaemia persisted in 34% (n = 16/47) of patients at the end of follow-up: 17% (2/12) of HIV-HCV-coinfected and 40% (14/35) of HCV-monoinfected patients. Among these patients, median cryoglobulin level decreased from 101.4 mg/L at DAA treatment initiation to 51.7 mg/L at the end of follow-up.

CONCLUSIONS: DAA-induced SVR allows cryoglobulin clearance in two-thirds of patients.