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Clinical and Developmental Immunology
Volume 2012, Article ID 315167, 8 pages
http://dx.doi.org/10.1155/2012/315167
Review Article

The Place of Immunotherapy in the Management of HCV-Induced Vasculitis: An Update

1Department of Internal Medicine, Centre de Compétence pour les Maladies Autoimmunes Systémiques PACA Ouest, Hôpital de la Conception, Marseille, France
2Department of Nephrology, Hôpital de la Conception, Université Aix-Marseille, Marseille, France

Received 26 April 2012; Accepted 3 July 2012

Academic Editor: Domenico Sansonno

Copyright © 2012 Laurent Chiche et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients with chronic hepatitis C virus (HCV) can develop systemic cryoglobulinemic vasculitis. Combination of pegylated-interferon α and ribavirin is the first-line treatment of this condition. However, in case of severe or life-threatening manifestations, absence of a virological response, or autonomized vasculitis, immunotherapy (alone or in addition to the antiviral regimen) is necessary. Rituximab is to date the only biologic with a sufficient level of evidence to support its use in this indication. Several studies have demonstrated that rituximab is highly effective when cryoglobulinaemic vasculitis is refractory to antiviral regimen, that association of rituximab with antiviral regimen may induce a better and faster clinical remission, and, recently, that rituximab is more efficient than traditional immunosuppressive treatments. Some issues with regard to the optimal dose of rituximab or its use as maintenance treatment remain unsolved. Interestingly, in balance with this anti-inflammatory strategy, a recent pilot study reported the significant expansion of circulating regulatory T lymphocytes with concomitant clinical improvement in patients with refractory HCV-induced cryoglobulinaemic vasculitis using low dose of subcutaneous interleukin-2. This paper provides an updated overview on the place of immunotherapy, especially biologics, in the management of HCV-induced cryoglobulinaemic vasculitis.