Mechanisms Involved in the Pathogenesis of Cryoglobulinemia in Patients with Chronic Hepatitis C and Other Causes of Chronic Liver Diseases

The purpose of this study was to investigate the mechanisms involved in the pathogenesis of cryoglobulinemia (CG) in patients with chronic liver diseases. One hundred and twenty-seven patients with chronic HCV infection, 41 patients with nonviral chronic liver diseases (LD), and 29 patients with chronic HBV infection were studied prospectively. Sera and cryoprecipitate (CP) were tested for the presence of HCV-RNA. Anti-HCV antibodies (Ab) and specific HCV proteins were detected in the CP. CG was found in 54% of patients with hepatitis C, 14% of patients with hepatitis B, and in 32% of patients with chronic LD. Anti-HCV Ab and HCV specific proteins were detected in the CP of 25/27 and 8/10 samples, respectively, and HCV-RNA sequences were demonstrated in the CP of 23/27 patients with HCV infection. The prevalence of cirrhosis was higher in patients with CG. However, CG was found more often in patients with HCV infection, and in 30% of noncirrhotic patients with chronic hepatitis C, suggesting that liver injury is not the only cause of CG. Furthermore, CG became undetectable in 10/25 patients treated with interferon. In conclusion, mechanisms by which CG are generated are probably multifactorial. Our results suggest that HCV may be responsible for the production of CG independently of the severity of liver damage.