entecavir and Cryoglobulinemia

Cryoglobulinemic vasculitis remains an uncommon complication of hepatitis B virus infection.. We report the case of a 40-years old female Chinese patient with chronic hepatitis B developing cryoglobulinemic vasculitis with multiple organ involvement (liver, kidney, and skin) coupled with weakness, arthralgias, haemolytic anaemia, and autoimmune thyroiditis. She received entecavir mono-therapy at dose adjusted for estimated glomerular filtration rate.. Within five months of entecavir treatment, hepatitis B viraemia decreased below the limit of detection with normal serum amino-transferase levels, HBeAg clearance occurred, vasculitis regressed with disappearance of purpura and ascites; in addition, renal function normalized and nephritic syndrome remitted. After a five-year follow-up, the patient is asymptomatic with intact kidney function, proteinuria in the normal range, and normal liver biochemistry, despite the antiviral treatment was withdrawn and the patient remained HBsAg positive.. This is the second case of hepatitis B virus-related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra-hepatic manifestations of infection by hepatitis B virus.

Topics: Adult; Antiviral Agents; Comorbidity; Cryoglobulinemia; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Guanine; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B, Chronic; Humans; Remission Induction; Transaminases; Treatment Outcome; Vasculitis

Reactivation of the hepatitis B virus (HBV) has been reported in patients with occult infection (OBI), i.e. HBV surface antigen (HBsAg) negative, HBV core antibody (anti-HBc) positive ± antibodies against HBsAg (anti-HBs) and detectable HBV DNA in serum or liver, receiving immunosuppressive or cytotoxic therapies. Recently, concerns have been raised regarding the risk of HBV reactivation in OBI patients treated with direct acting antiviral agents (DAAs) for chronic hepatitis C (CHC). Here we describe a case of HBV reactivation in a 72-year-old woman with OBI as a possible consequence of effective treatment with sofosbuvir (SOF) and ribavirin (Rbv) for genotype 2a/2c CHC.

Topics: Aged; Anti-Inflammatory Agents; Antiviral Agents; Cryoglobulinemia; DNA, Viral; Female; Guanine; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis C; Humans; Immunologic Factors; Prednisolone; Recurrence; Ribavirin; Rituximab; Sofosbuvir; Viral Load

Cryoglobulinemic vasculitis (CV) related to Hepatitis-B Virus (HBV) is rare and its treatment is ill-defined.. To describe clinical and treatment characteristics of HBV-related CV patients. In addition, the efficacy of treatment with antiviral agent nucleotide (NUC), including Entecavir, Adefovir, and Lamivudine, was explored.. In four Italian centres, 17 HBV-positive CV patients (median age 56 years, range 45-70) were enrolled.. The extrahepatic manifestations were: purpura (100%), arthralgias (71%), peripheral neuropathy (29%), chronic hepatitis (47%), liver cirrhosis (29%), and glomerulonephritis (18%). Mixed cryoglobulinemias were type II (88%) and type III (12%). The median cryocrit was 3% (range 1-14), rheumatoid factor was 200U/L (range 20-5850), C4 was 12mg/dl (range 2-31), ALT 71U/L (range 36-114). All patients were HBsAg-positive and 80% anti-HbeAg-positive. At enrollment, they were treated with steroids (eight), Entecavir (five), Alpha-IFN (two), Adefovir and Lamivudine (one each). After NUC treatment, no disease progression was observed and, in all patients, HBV-DNA became undetectable. Moreover, a regression of purpura and a reduction of cryocrit were observed. Four patients died during therapy, two of kidney failure and two of liver cirrhosis.. NUC therapy appeared to be safe and effective in CV-related HBV.

Topics: Adenine; Aged; Antiviral Agents; Cryoglobulinemia; Female; Guanine; Hepatitis B; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Italy; Lamivudine; Male; Middle Aged; Organophosphonates; Treatment Outcome; Vasculitis

Mixed cryoglobulinemia is occasionally seen in patients with hepatitis B virus (HBV) infection. This report presents the case of a quiescent HBV carrier who had type II mixed cryoglobulinemia, protracted purpura, ulcerative skin lesions and advanced chronic kidney disease. The cutaneous manifestations of the patient improved along with a decrease in the serum cryoglobulin and HBV-deoxyribonucleic acid levels following the initiation of oral entecavir in combination with plasmapheresis. However, the patient ultimately required prednisolone due to the limited benefits of these treatments. We also discuss various concerns regarding steroid treatment in patients with mixed cryoglobulinemia complicated by HBV infection.

Topics: Aged; Antiviral Agents; Combined Modality Therapy; Cryoglobulinemia; Cryoglobulins; DNA, Viral; Female; Guanine; Hepatitis B Antibodies; Hepatitis B Antigens; Hepatitis B, Chronic; Humans; Plasmapheresis; Prednisolone; Purpura; Renal Insufficiency, Chronic; Skin Ulcer

Topics: Antiviral Agents; Cryoglobulinemia; Guanine; Hepatitis B; Humans; Male; Middle Aged; Remission Induction; Vasculitis

Topics: Antiviral Agents; Cryoglobulinemia; Female; Guanine; Hepatitis B; Humans; Middle Aged; Treatment Outcome; Vasculitis