ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 831

No More HCV RNA in Serum and Cryoprecipitate in Patients with Persisting HCV-Cryoglobulinemia Vasculitis after Daa-Induced Sustained Virological Response

Patrice Cacoub1, Eve Todesco2, Pascale Ghillani-Dalbin3, Lucile Musset3 and David Saadoun4, 1Internal Medicine Department, University Hospital “Pitié-Salpêtrière”, “Pierre et Marie Curie Paris VI” University, Paris, France, Paris, France, 2Virology Pitie Salpetriere hospital, Paris, France, 3Immunobiology department Pitie Salpetriere Hospital, Paris, France, 4Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Date: Sunday, October 21, 2018

Title: Vasculitis Poster I: Non-ANCA-Associated and Related Disorders

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

No more HCV RNA in Serum and Cryoprecipitate in Patients with Persisting HCV-Cryoglobulinemia Vasculitis after DAA-induced Sustained Virological Response

Background/Purpose:

In addition to high antiviral efficacy, the new anti-HCV regimens (DAA) can improve most systemic manifestations of patients with HCV-mixed cryoglobulinemia vasculitis (HCV-CryoVas). However, 6 to 12 months after DAA, 50% to 61% of HCV-CryoVas patients still have detectable cryoglobulinemia and some of them still complain of CryoVas manifestations. The aim of the present study was to search for the presence of HCV RNA in serum and cryoprecipitate of HCV-CryoVas patients who had a sustained virological response after DAA and who remain cryoglobulin-positive.

Methods:

Samples of patients who had systemic manifestations of CryoVas, including 15 HCV-infected and 4 HCV-non infected patients were analyzed. All HCV-infected patients received all-oral interferon-free combinations for 12 to 24 weeks. Cryoglobulins were precipitated during 7 days at 4°C, then cryoprecipitates were washed. Cryoglobulins were quantified by spectrophotometry and identified by immunofixation. HCV RNA viral loads were performed on sera and cryoprecipitates (after dilution) by the automated Roche Cobas® 6800 platform (limit of detection: 15 IU/mL).  

Results:

HCV-infected CryoVas patients were aged 59±10 yrs, 9 females, 44% cirrhotics, 69% genotype 1 and 30% treatment-naïve. Patients received DAAs, i.e. SOF/RBV (N=7), SOF/DACLA (n=6), SOF/SIME (n=2), and SOF/DACLA/RBV (N=1). Three groups of HCV patients were defined based on the presence of HCV RNA (in serum and/or cryoprecipitate) and clinical manifestations of CryoVas (Table 1). Group 1 included samples of 5 patients with symptomatic CryoVas before DAAs. They all showed HCV positive viral load in serum and cryoprecipitate. Other patients with either both positive cryoglobulin and symptomatic Cryovas (group 2, n=4) or positive cryoglobulin and no symptom of vasculitis (group 3, n=6) proved all negative for the presence of HCV RNA in serum and cryoprecipitate after sustained virological response to DAAs. In addition, 4 HCV-seronegative patients who had symptomatic CryoVas were all negative for the presence of HCV RNA in their serum and cryoprecipitate.

Conclusion:

HCV-CryoVas patients who have a sustained virological response after DAA and who remain cryoglobulin-positive (symptomatic or not) do not have HCV RNA particles in their cryoprecipitate anymore. In such cases, the cryoglobulin production with or without vasculitis manifestations became autonomous and independent of HCV antigenic stimulation.

Table 1

Age (years)

gender

Cryo positive

Cryo type

Symptomatic vasculitis

HCV RNA (IU/mL)

serum

cryoprecipitate

Group 1

71/F*

Yes

2

Yes

59 400

1824

53/M*

Yes

2

Yes

27 892

8320

68/F*

Yes

2

Yes

344 378

14 275

65/M*

Yes

2

Yes

1610

15 100

62/F*

Yes

2

Yes

7639

96 000

Group 2

75/F

Yes

2

Yes

< 15

undetectable

54/M

Yes

2

Yes

< 15

undetectable

71/F*

Yes

2

Yes

< 15

undetectable

62/F*

Yes

2

Yes

< 15

undetectable

Group 3

68/F*

Yes

2

No

< 15

undetectable

56/F

Yes

3

No

< 15

undetectable

53/M*

Yes

2

No

< 15

undetectable

30/M

Yes

2

No

< 15

undetectable

53/M

Yes

2

No

< 15

undetectable

65/M*

Yes

2

No

< 15

undetectable

* Patients with samples analyzed before and after DAA-therapy. Cryo: cryoglobulin. IU: International Units


Disclosure: P. Cacoub, Abbvie, Astra Zeneca, Bristol-Myers Squibb, Gilead, Glaxo Smith Kline, Janssen, Merck Sharp Dohme, Roche, Servier and Vifor, 5; E. Todesco, None; P. Ghillani-Dalbin, None; L. Musset, None; D. Saadoun, Medimmune, Abbvie, Bristol Meyer Squibb, Roche, Servier, Gilead, AstraZeneca and Glaxo Smith Kline, 5.

To cite this abstract in AMA style:

Cacoub P, Todesco E, Ghillani-Dalbin P, Musset L, Saadoun D. No More HCV RNA in Serum and Cryoprecipitate in Patients with Persisting HCV-Cryoglobulinemia Vasculitis after Daa-Induced Sustained Virological Response [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/no-more-hcv-rna-in-serum-and-cryoprecipitate-in-patients-with-persisting-hcv-cryoglobulinemia-vasculitis-after-daa-induced-sustained-virological-response/. Accessed .

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/no-more-hcv-rna-in-serum-and-cryoprecipitate-in-patients-with-persisting-hcv-cryoglobulinemia-vasculitis-after-daa-induced-sustained-virological-response/