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Int. J. Mol. Sci. 2015, 16(6), 14075-14085; doi:10.3390/ijms160614075

Successful and Safe Long-Term Standard Antiviral Therapy in a Patient with “Explosive” Immune Response in Course of HCV-Related Liver Cirrhosis

1
Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, 80131 Naples, Italy
2
Haematology Unit, Federico II University Medical School of Naples, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Tatsuo Kanda
Received: 22 April 2015 / Revised: 10 June 2015 / Accepted: 12 June 2015 / Published: 19 June 2015
(This article belongs to the Special Issue Viral Hepatitis Research)
View Full-Text   |   Download PDF [689 KB, uploaded 19 June 2015]

Abstract

Hepatitis C virus (HCV) has been recognized to be both a hepato- and lymphotropic virus. HCV lymphotropism represents an essential detail in the pathogenesis of virus-related autoimmune and lymphoproliferative disorders, ranging from clonal expansion of B-cells with organ and non-organ-specific autoantibody production up to overt non-Hodgkin’s lymphoma along a continuous step-by-step model of B-cell lymphomagenesis, where the intermediated mixed cryoglobulinemia could be considered as a stage of suppressible antigen-driven lymphoproliferation. The HCV long-lasting extrahepatic replicative state generates an abnormal systemic immunological response, including rheumatoid factor (RF) and cryo- and non-cryoprecipitable immune complexes, as well as clinical manifestations, comprising dermatitis, polyarthralgias and arthritis, pulmonary disease, aplastic anemia, glomerulonephritis and vasculitis. The mechanism of these extra-hepatic disorders is thought of as linked to immune complex disease, but their pathogenesis is poorly clarified. Immune-suppressive treatment could induce high-level hepatitis C viremia and impair hepatic disease. We report a female patient, whose chronic HCV-related liver cirrhosis with associated explosive, but oligosymptomatic lymphoproliferative immune response, i.e., RF beyond three thousand times the upper of normal range (unr), type II cryoglobulinemia with cryocrit 40% and monoclonal gammopathy IgM-k, has been successfully and safely treated by long-lasting (sixty-six months) combined antiviral therapy (pegylated interferon alfa and ribavirin), at moderate and tapering dose regimen, prolonged for nearly 24 months after the first viral suppression. At the last follow-up (fifty-one months), the patient was showing very-long term antiviral response, progressive decline of secondary immune activation and absence of significant side-effects. Further research is required to fully verify the real impact on therapeutic choice/regimen. View Full-Text
Keywords: hepatitis C infection; lymphoproliferative disorders; cryoblobulins; rheumatoid factor; antiviral treatment hepatitis C infection; lymphoproliferative disorders; cryoblobulins; rheumatoid factor; antiviral treatment
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Conca, P.; Cafaro, G.; De Renzo, A.; Coppola, A.; Cimino, E.; Tarantino, G. Successful and Safe Long-Term Standard Antiviral Therapy in a Patient with “Explosive” Immune Response in Course of HCV-Related Liver Cirrhosis. Int. J. Mol. Sci. 2015, 16, 14075-14085.

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