Danishwar Mahmood, Jamil Zahid, Khan Salman, Nakhla Michael, Ahmad Ishtiaq, Ali Muhammad Ashar, Lau Daryl T Y
Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02115, USA.
J Clin Med. 2022 Feb 14;11(4):984. doi: 10.3390/jcm11040984.
Treatment with a direct acting antiviral (DAA) has revolutionized HCV therapy, as more than 95% of patients achieve a sustained virological response (SVR). Cryoglobulinemic vasculitis (CryoVas), however, can persist and recur after the HCV cure. In this systematic review, we include data from 19 studies that provided information on the persistence and recurrence of CryoVas after the HCV cure with DAAs. A complete clinical response (CR) was reported in 63.7% to 90.2% of the DAA-treated patients after achieving SVR. Relapse of CryoVas symptoms was reported in 4% to 18% of the patients. Neuropathy, nephropathy, and dermatological complications were the most common manifestations of CryoVas. B-cell clones persisted in 31-40% of the patients and could contribute to CryoVas relapse. INFL3-rs12979860, ARNTL-rs648122, RETN-rs1423096, and SERPINE1-rs6976053 were associated with a higher incidence of persistence and recurrence of CryoVas. Prospective multicenter studies with diverse patient populations are needed to validate these findings for the timely and effective management of this challenging condition.
直接作用抗病毒药物（DAA）治疗彻底改变了丙型肝炎病毒（HCV）的治疗方式，因为超过95%的患者实现了持续病毒学应答（SVR）。然而，冷球蛋白血症性血管炎（CryoVas）在HCV治愈后可能持续存在并复发。在这项系统评价中，我们纳入了19项研究的数据，这些研究提供了关于使用DAA治愈HCV后CryoVas持续存在和复发的信息。在实现SVR后，63.7%至90.2%接受DAA治疗的患者报告有完全临床缓解（CR）。4%至18%的患者报告有CryoVas症状复发。神经病变、肾脏病变和皮肤并发症是CryoVas最常见的表现。31%至40%的患者中B细胞克隆持续存在，可能导致CryoVas复发。INFL3-rs12979860、ARNTL-rs648122、RETN-rs1423096和SERPINE1-rs6976053与CryoVas持续存在和复发的较高发生率相关。需要开展针对不同患者群体的前瞻性多中心研究，以验证这些发现，从而及时有效地管理这一具有挑战性的病症。
