Factors predisposing to the occurrence of cryoglobulinemia in two cohorts of Egyptian and Japanese patients with chronic hepatitis C infection: Ethnic and genotypic influence

Abstract

The association between cryoglobulinemia and hepatitis C virus (HCV) infection has been reported. However, the factors underlying its wide variation of occurrence have not yet been well identified. To investigate this, cryoglobulinemia was studied in four cohorts of Egyptian and Japanese patients. Fifty Egyptian patients with chronic hepatitis C, infected with genotype 4 (the predominant HCV genotype in Egypt), were compared with 50 age- and sex-matched Japanese patients, infected with HCV genotype 1b (the predominant HCV genotype in Japan). Thirty-two Egyptian and 30 age- and sex-matched Japanese patients with chronic hepatitis B were included as controls. All patients were noncirrhotic. Antinuclear antibody (ANA), immunoglobulins (Ig), and cryoglubulins were assessed. Results showed a significantly higher prevalence of cryoglobulinemia in chronic hepatitis C Japanese genotype 1b (40%) as compared with Egyptian genotype 4 (14%), P = 0.003, while no difference was found between Japanese (17%) and Egyptian chronic hepatitis B controls (13%). Symptomatic cryoglobulinemia was more prevalent in the Japanese than in the Egyptian chronic hepatitis C group (10% vs. 4%), but the difference was not statistically significant. Univariate analysis showed no association between cryoglobulinemia and either age, sex, alanine aminotransferase level, or HCV viral load in Japanese or Egyptian patients, while the mean IgM level was significantly higher in the cryoglobulin-positive than in the cryoglobulin-negative chronic hepatitis C patients in each group (P = 0.003 and 0.017, respectively). Cryoglobulinemia was found to be significantly associated with both high IgG level (P = 0.020), and positive ANA (P < 0.001) in Japanese patients with chronic hepatitis C, genotype 1b but not in Egyptians with genotype 4. Multivariate analysis showed that the only factors predisposing to cryoglobulinemia were Japanese ethnicity with HCV genotype1b (P = 0.002, OR = 2.56), high IgM level of >245 mg/dl (P = 0.018, OR = 2.05) and female gender (P = 0.040, OR = 1/0.66). In conclusion, cryoglobulinemia is prevalent in Japanese patients with chronic hepatitis C infected with genotype 1b, but cryoglobulinemia is not common in Egyptians with HCV genotype 4. Although it was not possible to evaluate ethnicity and HCV genotype separately in this study, HCV genotype 1b appears to predispose more to cryoglobulinemia than does genotype 4. Female gender and high serum IgM level were also related.

Cryoglobulinaemia associated with hepatitis C virus: influence of HCV genotypes, HCV‐RNA viraemia and HIV coinfection

“…We found genotype 1b as the predominant HCV genotype in our cryoglobulinaemic patients, while in a small series of Italian patients with extrahepatic manifestations, the most frequent genotype was 2c [11]. Gad et al [12] analysed the prevalence and clinical significance of cryoglobulinaemia in 50 Egyptian patients with genotype 4 (the predominant HCV genotype in Egypt) and in 50 age‐sex‐matched Japanese patients with genotype 1b (the predominant HCV genotype in Japan). Results showed a significantly higher prevalence of circulating cryoglobulins (40% vs 14%) and symptomatic cryoglobulinaemia (10% vs 4%) in Japanese compared with Egyptians patients.…”

Schistosoma mansoni coinfection could have a protective effect against mixed cryoglobulinaemia in hepatitis C patients

“…However, the factors underlying its wide geographical variation of prevalence have not yet been well identified. Although a striking association (4 90%) between MC and HCV infection has been established in the Mediterranean area (14,15), HCV-related MC has been reported to be uncommon in Egypt (16). Although HCV infection is endemic in both Egypt and Japan, Gad et al (16) showed a significantly higher prevalence of MC in chronic HCV Japanese patients (40%) as compared with Egyptian patients (14%).…”

“…Although a striking association (4 90%) between MC and HCV infection has been established in the Mediterranean area (14,15), HCV-related MC has been reported to be uncommon in Egypt (16). Although HCV infection is endemic in both Egypt and Japan, Gad et al (16) showed a significantly higher prevalence of MC in chronic HCV Japanese patients (40%) as compared with Egyptian patients (14%). They concluded that HCV-related MC is prevalent in Japan but not in Egypt and that the Japanese ethnicity with genotype 1b (the predominant HCV genotype in Japan) was the factor predisposing to cryoglobulinaemia.…”

Leukocytoclastic vasculitis and necrolytic acral erythema in patients with hepatitis C infection: Do viral load and viral genotype play a role?

“…One study showed that genotype 2 was more prevalent among patients with HCV and cryoglobulinemia (76.6%), 34 whereas another study found that genotype 1 was more associated with development of cryoglobulinemic vasculitis. 25 Moreover, Gadet al, 35 in 2003, found that HCV genotype 1b in Japanese patients was more frequently associated with cryoglobulinemia than genotype 4 in Egyptian patients, however, ethnicity and genetic factors could have played a role in their findings. Other investigators found no difference in genotype prevalence between HCV-related cryoglobulinemia and chronic HCV without cryoglobulinemia.…”