Therapy for Hepatitis C Virus–Related Cryoglobulinemic Vasculitis

Cryoglobulins are present in about a quarter of patients with hepatitis C; in some, cryoglobulinemia can become symptomatic or even life-threatening. This review summarizes evolving therapy for the disorder, including new therapeutic options that are becoming available. Cryoglobulins are immunoglobulins characterized by their insolubility at low temperatures and their dissolution after rewarming. 1 , 2 On the basis of their immunochemical composition, cryoglobulins are classified as either single (type I), consisting of a monoclonal immunoglobulin, or mixed, comprising two or more immunoglobulin isotypes, with (type II) or without (type III) a monoclonal component. 3 For many years, mixed cryoglobulinemia was referred to as “essential” because of its undefined cause. In the early 1990s, it became evident that more than 90% of patients with mixed cryoglobulinemia were infected with hepatitis C virus (HCV). 4 – 7 The pathophysiology of mixed cryoglobulinemia, as it . . .