Saadoun David, Aaron Laurent, Resche-Rigon Mathieu, Pialoux Gilles, Piette Jean-Charles, Cacoub Patrice
Service de Médecine Interne, Hôpital La Pitié-Salpêtrière, Paris, France.
AIDS. 2006 Apr 4;20(6):871-7. doi: 10.1097/01.aids.0000218551.62210.b5.
To describe mixed cryoglobulinaemia (MC) vasculitis in patients coinfected with hepatitis C virus (HCV) and HIV.
Retrospective multicentre study through the GERMIVIC Database of 4005 HIV/HCV-coinfected patients.
The characteristics and outcome of 11 HIV/HCV-coinfected patients with MC vasculitis were analysed and compared with those of 118 HCV-infected patients with MC vasculitis.
The mean age was 46 years (SD, 14), with 82% male. The median initial CD4 cell count was 367 cells/microl (range, 252-846). After a mean follow-up of 44.4 months, two deaths (18%) were noted. Clinical manifestations of MC included polyneuropathy in seven (64%), purpura in four (36%), arthralgia in four (36%), and kidney involvement in three (27%). Six patients received combination treatment with interferon-alfa and ribavirin, three of whom had sustained HCV virological response and were complete clinical responders. Four patients received corticosteroids and two showed a partial clinical response. Regardless of the HIV virological response, antiretroviral therapy did not improve MC vasculitis. Compared with patients with HCV monoinfection, coinfected patients were younger (P < 0.001), more frequently male (P = 0.03), more frequently intravenous drug users (P < 0.001), had higher HCV viraemia (P = 0.004), higher liver necroinflammation (P = 0.03), higher gammaglobulinaemia (P < 0.001) and lower cryoglobulin level (P = 0.03). The clinical manifestations of MC vasculitis did not differ significantly between the two groups.
There was a beneficial effect of anti-HCV therapy for HIV/HCV-coinfected patients with MC vasculitis.
描述丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染患者的混合性冷球蛋白血症（MC）血管炎。
通过GERMIVIC数据库对4005例HIV/HCV合并感染患者进行回顾性多中心研究。
分析11例HIV/HCV合并感染的MC血管炎患者的特征和结局，并与118例HCV感染的MC血管炎患者进行比较。
平均年龄为46岁（标准差，14），男性占82%。初始CD4细胞计数中位数为367个/微升（范围，252 - 846）。平均随访44.4个月后，有2例死亡（18%）。MC的临床表现包括7例（64%）出现多发性神经病，4例（36%）出现紫癜，4例（36%）出现关节痛，3例（27%）出现肾脏受累。6例患者接受了干扰素-α和利巴韦林联合治疗，其中3例实现了HCV病毒学持续应答且为完全临床缓解者。4例患者接受了皮质类固醇治疗，2例显示部分临床缓解。无论HIV病毒学应答情况如何，抗逆转录病毒治疗均未改善MC血管炎。与单纯HCV感染患者相比，合并感染患者更年轻（P < 0.001），男性比例更高（P = 0.03），静脉吸毒者比例更高（P < 0.001），HCV病毒血症更高（P = 0.004），肝脏坏死性炎症更高（P = 0.03），γ球蛋白血症更高（P < 0.001），冷球蛋白水平更低（P = 0.03）。两组MC血管炎的临床表现无显著差异。
抗HCV治疗对HIV/HCV合并感染的MC血管炎患者有有益作用。
