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Cryoglobulinaemia in HCV infection: coming in from the cold
  1. Department of Clinical Medicine
  2. Cambridge University School of Clinical Medicine
  3. Addenbrooke’s NHS Trust
  4. Cambridge CB2 2QQ, UK

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See article on page 122

Hepatitis C virus (HCV) antibodies are detected in up to 1.5% of blood donors worldwide and HCV is estimated to infect at least 4 million people in the USA alone.1 HCV is probably the commonest cause of liver disease and hepatocellular carcinoma in the developed world and has become the leading reason for liver transplantation in many centres. HCV is thought to be the aetiological factor in the majority of cases of mixed cryoglobulinaemia in which HCV RNA is concentrated in high titre in cryoprecipitates.2Conversely, up to 54% of patients with HCV infection have detectable cryoglobulins, which are associated with symptoms in roughly 25%, most commonly including cutaneous manifestations and arthralgias but much less often glomerulonephritis and neurological abnormalities.3 Although some studies have noted a correlation between the severity of liver disease and the level of cryoglobulins in serum, this has not been a consistent observation.

In this issue (see page 122), Cresta and colleagues studied 87 patients with HCV related liver disease prospectively. Forty three of the patients had detectable cryoglobulins, associated with symptoms in 12 …

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