Related Experiment Video
Updated: Dec 18, 2025
The CYP2D6 Animal Model: How to Induce Autoimmune Hepatitis in Mice
Published on: February 3, 2012
Cryoglobulinemia after the era of chronic hepatitis C infection
Gonçalo Boleto1, Pascale Ghillani-Dalbin2, Lucile Musset2
1Sorbonne Université, UPMC Univ Paris 06, UMR 7211, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France, CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France; Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose, France.
Insights
Direct-acting antivirals have significantly reduced mixed cryoglobulinemia (MC) cases. While hepatitis C virus (HCV) was the primary cause, autoimmune diseases now dominate MC diagnoses.
Area of Science:
- Rheumatology and Immunology
- Hepatology
- Infectious Diseases
Background:
- Historically, chronic hepatitis C virus (HCV) infection was the leading cause of mixed cryoglobulinemia (MC).
- The introduction of direct-acting antivirals (DAA) for HCV has altered the epidemiological landscape of HCV infection.
Purpose of the Study:
- To investigate the spectrum of mixed cryoglobulinemia (MC) in the era of direct-acting antiviral (DAA) therapy.
- To evaluate the changes in MC incidence and causes before and after DAA availability.
- To compare the characteristics of HCV-related and non-HCV-related MC.
Main Methods:
- A longitudinal cohort study was conducted from 2011 to 2018 at a French university hospital.
- Data from 15,970 patients screened for MC were analyzed, including epidemiological, clinical, and immunological factors.
- The incidence and evolution of MC were assessed, comparing periods before and after DAA introduction.
Main Results:
- The incidence of MC significantly decreased from 395 cases (2011-2014) to 284 cases (2015-2018).
- Chronic HCV infection, initially the main cause of MC (62.5% in 2011), has been surpassed by autoimmune diseases (e.g., lupus, Sjögren's syndrome).
- The incidence of cryoglobulinemia vasculitis (CryoVas) was comparable between HCV-related and non-HCV-related MC.
Conclusions:
- Direct-acting antiviral agents have profoundly impacted the incidence and etiological landscape of mixed cryoglobulinemia.
- Autoimmune conditions are now the predominant drivers of MC, highlighting a shift from viral etiology.
Objectives:
Historically chronic hepatitis C virus (HCV) infection accounted for the majority of mixed cryoglobulinemia (MC). The advent of direct-acting antivirals (DAA) against HCV has dramatically changed the management and the prevalence of chronic HCV infection. We aimed to describe the spectrum of MC in the era of DAA agents.
Methods:
We performed a longitudinal cohort study between 2011 and 2018 from a single-center French university hospital's database of 15 970 patients screened for MC. Epidemiological, clinical and immunological data of MC were recorded. We evaluated the incidence and evolution of MC before and after the era of DAA agents and compared HCV and non-HCV related MC.
Results:
Among 742 patients who tested positive for cryoglobulin, 679 [mean age 55.5 years, 54.5% female and 381 (56.1%) with chronic HCV infection] patients with persistent MC were included in the study. 373 (54.9%) had type II and 306 (45.1%) type III cryoglobulin, and 139 (21.5%) had cryoglobulinemia vasculitis (CryoVas). The incidence of MC decreased steadily with 395 and 284 incident cases during 2011-2014 and 2015-2018, respectively. In 2011, the leading cause was chronic HCV infection (62.5% of all MC). Currently, autoimmune diseases [systemic lupus erythematosus (28.9%) and Sjögren's syndrome (10.7%)] are the main cause of MC. The incidence of CryoVas was similar between HCV-and non HCV-related MC.
Conclusion:
Direct-acting antivirals have dramatically changed the landscape and the incidence of MC.
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:24Nephrotic Syndrome I : Introduction
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:26Nephrotic Syndrome II : Assessment and Medical Management
01:24Chronic Kidney Disease II: Clinical Manifestations