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Published on: September 25, 2019
[Hepatitis C virus-associated cryoglobulinemic vasculitis: A 20-year experience with treatment]
T M Ignatova1, L V Kozlovskaya2, N B Gordovskaya2
1I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.
Insights
Antiviral therapy (AVT) is the preferred treatment for hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV). For severe cases, combining AVT with rituximab offers the best outcomes for patients with HCV-associated CV.
Area of Science:
- Hepatology
- Rheumatology
- Immunology
Background:
- Hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV) is a serious condition impacting patient prognosis.
- Understanding treatment efficacy is crucial for managing this complex autoimmune manifestation.
Purpose of the Study:
- To evaluate the treatment experience of a multidisciplinary hospital for HCV-associated CV.
- To compare the effectiveness of different therapeutic strategies, including antiviral therapy (AVT) and immunosuppressive therapy (IST).
Main Methods:
- Retrospective analysis of 72 patients with HCV-associated CV.
- Assessment of traditional IST (corticosteroids ± cyclophosphamide), rituximab, and AVT.
- Vasculitis activity measured by Birmingham vasculitis activity score (BVAS); survival and prognostic factors analyzed.
Main Results:
- Antiviral therapy (AVT) achieved clinical remission in 68% of patients and showed long-term advantages over IST.
- Rituximab was more effective than traditional IST (73% vs. 13% remission).
- Combined AVT and rituximab demonstrated highest efficacy in severe CV cases; factors like age >55, liver cirrhosis, and renal failure adversely affected prognosis.
Conclusions:
- Antiviral therapy (AVT) is the primary treatment for HCV-associated CV.
- Combination therapy with AVT and rituximab is recommended for severe CV presentations.
- HCV-associated CV significantly influences the prognosis of chronic HCV infection.
Aim:
To summarize the experience of a multidisciplinary therapy hospital in treating patients with hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV).
Subjects And Methods:
Seventy-two patients (mean age, 49.4±10.3 years) with HCV-associated CV were examined and followed up for an average period of 2.8±3.6 years. The efficiency of traditional (corticosteroids ± cyclophosphamide) and selective (rituximab) immunosuppressive therapy (IST) was estimated in 31 and 15 observations, respectively, and that of antiviral therapy (AVT) in 25. Vasculitis activity was assessed using the Birmingham vasculitis activity score (BVAS). The patients' survival was studied; multivariate logistic regression analysis was carried out.
Results:
24 (33.4%) of the 72 patients had a stage of liver cirrhosis (LC). The pretreatment mean BVAS was 11.9±7.2 (range 2 to 36). Severe CV (BVAS ≥15) was present in 30.6% of the patients. AVT was accompanied by achievement of sustained virologic response in 48% of the patients, clinical remission in 68% and had an advantage over IST in relation to long-term treatment results. Rituximab was significantly more effective than traditional immunosuppressants (remission rates of 73 and 13%, respectively). Combined therapy (rituximab and AVT) was most effective in patients with severe forms of vasculitis. Sixteen patients died from complications of vasculitis (37.5%), infection (37.5%), and LC (25%). The factors adversely affecting prognosis were age >55 years (odds ratio (OR), 4.49), the presence of LC (OR, 3.68), renal failure (OR, 4.66) and the use of glucocorticosteroids (OR, 3.91).
Conclusion:
HCV-associated CV can determine the prognosis of chronic HСV infection. AVT is the treatment of choice in all patients with HСV-associated CV. AVT must be combined with rituximab therapy in patients with severe forms of vasculitis.
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