difficult. Nonetheless, previous work found no increased prevalence of cryoglobulinemia in patients with B cell frequencies of >20% of the lymphocyte population. 7 The decreased B cell numbers in our study do not contradict the large expansions in specific B cell clones observed in cryoglobulinemia. Clonal B cell populations in the activated/memory B cell subset drive MC, and we did not identify reductions in this subset. Rather, we found the percentage of these cells in the total B cell population to be increased and resistant to apoptosis.With regard to the comment that our observations may be related to changes in B cell homing, we observed differential chemokine receptor expression on B cells from healthy controls and HCV patients, but no significant difference among HCV patients with and without MC. Thus, there is no evidence of differential B cell homing.The high percentage of men in our study is indeed interesting, and the possibility that sex and perhaps hormonal differences may explain the differences reported among studies is worth exploring. Of note, a large retrospective cohort study of 146,394 patients of Veterans Affairs health care facilities in the United States, in which 97% of the patients were male, also demonstrated an increased risk of cryoglobulinemia for HCV-infected men. 8

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