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Letter to the editor: High rate of clinical and immunological response in patients with HCV‐associated cryoglobulinemia

To the editor, We have read with interest the article by Kondili et al.[1] The results of this study indicate that longterm monitoring of patients with HCVassociated cryoglobulinemic vasculitis (CV) is required after treatment with directacting antivirals (DAAs). Despite the high rate of clinical improvement, the symptoms of CV fluctuated during the followup, and nearly a half of the patients had a deterioration of initial response. Several studies demonstrate the importance of longterm followup in patients with HCVCV.[2,3] In the past we have shown persistent cryoglobulinemia and CV after HCV eradication.[3] Here, we report data on nine symptomatic (CV) patients and 20 patients with asymptomatic cryoglobulinemia, treated with DAAs ± ribavirin (Table 1). The activity of HCVCV was assessed using the Birmingham Vasculitis Activity Score, version 3 (BVAS.v3). The median followup period was 26 (15– 36) months after treatment cessation. All patients achieved sustained virological response at 12 weeks. Cryoglobulins disappeared at the end of treatment in 11 (37.9%) patients (in four [44.4%] symptomatic and seven [35%] asymptomatic patients). During followup eight more patients achieved cryoglobulin elimination, and one patient had recurrence of cryoglobulinemia. The overall cryoglobulinemia elimination rate was 62.1%. Of the nine symptomatic patients, clinical response was complete (defined by a BVAS.v3 score of 0) in four (44.4%) patients and partial response (defined by a BVAS.v3 score < 50% of the baseline score) in two (22.2%) patients. During the followup one more patient achieved complete clinical response, and the overall rate of clinical response was 77.7%. Skin purpura (66.7% reduction), joint manifestation (60% reduction), and renal impairment (75% reduction) were most likely to resolve, with a lower rate of response in neurological symptoms (25%). Our study had a longer observational period than the study by Kondili et al. We also demonstrated high rates of virological, clinical, and immunological responses in DAAtreated patients with HCVCV and cryoglobulinemia, which increased during the followup. In the article by Kondili et al., nearly 50% of patients had deterioration of the clinical response, whereas in our cohort only one patient (3.5%) experienced transitory clinical relapse and a recurrence of cryoglobulinemia after treatment cessation. These differences may Received: 9 February 2022 | Accepted: 9 February 2022