Background: Up to 74% of patients affected by HCV have HCV-related extrahepatic manifestation (EHMs) including autoimmune diseases, mixed cryoglobulinemia (MC) and non-Hodgkin lymphomas (NHL).Objective: To study the impact of treatment with direct acting antiviral agents (DAAS) on mixed cryoglobulinemia of HCV Egyptian patients.
Patients and methods: This study was carried out in cooperation between the Hepato-gastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, and Shebin Elkom Fever Hospital from March 2018 to December 2019. The study included 80 patients with HCV-related EHMs including cutaneous (30 patients), musculoskeletal (30 patients) and renal manifestation (20 patients). All patients were naïve to treatment with DAAs (Sofosbuvir/Daclatasvir ± Ribavirin regimen).
Results: Purpuric papules of the lower extremities were the most frequent cutaneous lesion (80%), and arthralgia was the most frequent in musculoskeletal manifestations (90%). Diffuse membranoproliferative glomerulonephritis was the most frequent lesion in patients, with renal manifestations (90%). Significant increase occurred in the serum cryoglobulin levels and RF, with significant decreasein C3 and C4 serum levels in all groups. There were significant decrease in the mean cryoglobulin levels from positive to negative, with significant decline in RF concentrations, and rise in C3 and C4 serum levels approaching the normal values. There were improvements in the presenting HCV-MC clinical manifestations in variable degrees, rangingfrom 71.42% in patients with glomerulonephritis to 98.4% in patients with purpura. Eighty-seven percent of the included patients showed complete response (clinical, virologicaland immunological recovery), and 13% showed partial response (virological and immunological recovery without clinical improvement of cryoglobulinemia associated manifestations).
Conclusion: DAAs, in the form of Sofosbuvir/Daclatasvir ± Ribavirin regimen, were treatment of choice for HCV infection, and considered in cases of HCV-MC as they were associated with clinical improvement in most patients.