Absence of HCV RNA in serum and cryoprecipitate of patients with persisting mixed cryoglobulinaemia vasculitis after direct‐acting antiviral agents. Issue 3 (7th May 2019) - Cacoub, Patrice
Abstract: Objective: The objective of this study was to search for the presence of HCV RNA in serum and cryoprecipitate of patients presenting with HCV‐cryoglobulinaemia vasculitis (HCV‐CryoVas) after direct‐acting agents (DAAs). Methods: Samples of 15 HCV‐infected and 4 HCV‐non‐infected symptomatic CryoVas patients were analysed. All HCV‐infected patients received interferon‐free DAAs. HCV RNA viral loads were performed on sera and cryoprecipitates. Results: HCV‐infected CryoVas patients were aged 59 ± 10 years, including 44% cirrhotic. Three groups of HCV patients were defined based on the presence of clinical manifestations of CryoVas and cryoglobulin in the serum. Group 1 included five patients with symptomatic CryoVas before DAAs. They were all found positive for HCV viral load and cryoprecipitate. All other patients with either both positive cryoglobulin and symptomatic Cryovas (group 2, n = 4) or positive cryoglobulin without symptom (group 3, n = 6) proved negative for the presence of HCV RNA in serum and cryoprecipitate after sustained virological response to DAAs. In addition, four HCV‐seronegative patients who had symptomatic CryoVas were all tested negative for the presence of HCV RNA in their serum and cryoprecipitate. Conclusions: HCV‐CryoVas patients who remain cryoglobulin positive after DAAs do not have HCV RNA in their cryoprecipitate anymore, suggesting that cryoglobulin production became autonomous.