Mixed cryoglobulinemia in patients with HIV or HIV/HCV and chronic kidney disease

Introduction: the mixed cryoglobulinemia (MC) can develop at a number of infectious diseases, most often in patients with the persistent infection caused by the hepatitis C virus (HCV). Cryoglobulin proteins precipitate in microvascular bed and induce inflammatory and proliferative responses. Glomerular injury is the most serious complication of MC. The frequency of kidney involvement in patients co-infected with HIV and HCV remains to be studied. The aim of the research was to determine the incidence of MC associated chronic kidney disease (CKD) in patients co-infected with HIV and HCV. Methods: 76 HIV infected adult patients suffering from CKD with HIV/HCV coinfection (56 patients) and without signs of chronic viral hepatitis (20 patients) participated in the study. Results: the frequency of laboratory diagnosed MC was 39.5%. Among patients infected only with HIV, MC was found statistically less frequent than in HIV/HCV co-infected ones: 5.0% (1/20) vs. 51.8% (29/56), р<0.001. Logistic regression analysis has shown that the HCV co-infection was the only significant and independent factor for the development of MC - Exp(B)=0.046, 95% DI: 0.006-0.379, р=0.004. In patients with MC, glomerular damage was significantly more frequent manifested. Nephrotic and/or nephritic syndrome was found in 70% (21/30) of HIV infected patients vs. 22% (10/46) patients without MC (р<0.001). During follow up (1 to 25 months), 11 of HIV-infected (14%) died. There was no statistically significant association between MC and mortality in our cohort. Conclusions: frequency of mixed cryoglobulinemia is high in population of HIV-positive people. It is associated with symptoms of kidneys damage and co-infection with HCV.

криоглобулинемия, вирус иммунодефицита человека, ВИЧ, вирус гепатита С, хронический гепатит С, хроническая болезнь почек, нефропатия, гломерулопатия, cryoglobulinemia, human immunodeficiency virus, HIV, hepatitis C virus, HCV, chronic hepatitis C, chronic kidney disease, nephropathy, glomerulopathy

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