Abstract
Hepatitis B virus (HBV) chronic infection causes progressive liver damage, although about 20% of patients develop extrahepatic manifestations such as cryoglobulinemic vasculitis (CV). Clinical manifestations range from mild to moderate (purpura, asthenia, arthralgia) to severe (leg ulcers, peripheral neuropathy, glomerulonephritis, non-Hodgkin lymphoma). A comprehensive review of therapeutic options for HBV-related CV is lacking. Nucleos(t)ide analogues (NA) suppress HBV replication in 90–100% of cases and induce clinical response in most patients with mild-to-moderate CV. Plasma exchange can be performed in patients with severe CV and should be considered in severe or life-threatening cases combined with high doses of corticosteroids and antiviral treatment. A cautious use of rituximab can be considered only in association with NA treatment in refractory cases. A review of the literature and an analysis of data collected by six centers of the Italian Group for the Study of Cryoglobulinemia on 18 HBV-CV nucleotide/nucleoside analogues (NAs)-treated patients were carried out.
Highlights
Hepatitis B virus (HBV) infection is still a major global health problem with about350 million chronically infected subjects worldwide
In a recent study on 12 patients affected by HBV-membranoproliferative glomerulonephritis (MPGN) [30], proteinuria was present with a nephrotic range in all of them, and 9 (75%) patients had impaired renal function
The literature reviews described, together with the original results we reported in a long-term follow-up of the largest series of patients treated with Nucleos(t)ide analogues (NA), suggest that HBV replication is the triggering factor, and antiviral therapy may be the first-line treatment
Summary
Hepatitis B virus (HBV) infection is still a major global health problem with about. 350 million chronically infected subjects worldwide. In types II and III, called mixed cryoglobulinemia (MC), the cryoglobulins are immunocomplexes composed by the antigen and monoclonal IgMs or polyclonal IgGs. The IgMs are usually endowed with rheumatoid factor (RF) activity against polyclonal IgGs. MC is strongly associated with HCV infection (80–90%) [8], but a fraction of cases is HCV-negative (10–20%), being secondary to other viral infections (HBV and HIV are the most common), or to systemic autoimmune diseases (primary Sjögren’s syndrome, systemic lupus erythematosus, and rheumatoid arthritis), or to chronic lymphoproliferative disorders [9,10,11,12,13,14,15,16,17,18,19,20]. Our review focuses on clinical manifestations and treatments for HBV-related CV
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
