Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population

Dipartimento di Scienze Neurologiche, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, and Department of Neurology, Hospital Maggiore, Lodi, Italy.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 05/2006; 77(5):626-9. DOI: 10.1136/jnnp.2005.081570
Source: PubMed


To assess the prevalence of peripheral neuropathy (PN) and its correlation with cryoglobulinemia (CG) in an unselected, untreated referral hepatitis C virus (HCV) population.
Two hundred and thirty four patients (120 women and 114 men) with untreated HCV infection were consecutively enrolled by seven Italian centres. Clinical neuropathy was diagnosed when symptoms and signs of peripheral sensory or motor involvement were present. Median, ulnar, peroneal, and sural nerves were explored in all patients and distal symmetric polyneuropathy was diagnosed when all explored nerves or both lower limb nerves were affected. Mononeuropathy and mononeuropathy multiplex were diagnosed when one nerve or two non-contiguous nerves with asymmetrical distribution were affected. Screening for CG was done in 191 unselected patients.
Clinical signs of PN were observed in 25 of the 234 patients (10.6%). Electrophysiological PN was found in 36 (15.3%). CG was present in 56/191 patients (29.3%). The prevalence of CG increased significantly with age (p<0.001) and disease duration (p<0.05). PN was present in 12/56 (21%) patients with CG and 18/135 (13%) without CG (p=NS). PN increased significantly with age (p<0.001) and logistic regression analysis confirmed age as the only independent predictor of PN (OR 1.10 for each year; 95% CI 1.04 to 1.15; p<0.001).
Electrophysiological examination detected subclinical neuropathy in 11 patients (4.7%). Statistical analysis showed that CG was not a risk factor for PN whereas PN prevalence increased significantly with age.

Download full-text


Available from: Ettore Beghi
  • Source
    • "The pathophysiology of HCV related PN remains largely speculative; vascular deposition of HCV-RNA containing cryoglobulins (CGs), direct viral infection or perivascular mononuclear inflammatory cells may be at the origin of HCV associated inflammatory vascular lesions. However, it is likely that HCV neuropathy results from virus triggered immune mediated mechanisms rather than from direct nerve infection and in situ replication [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim of the workThe present study was undertaken to assess prevalence and characteristics of peripheral neuropathy (PN) in Egyptian hepatitis C virus (HCV) patients.Patients and methodsEighty newly diagnosed HCV patients were enrolled, with 20 healthy volunteers. All were subjected to: full clinical examination, neurological examination, laboratory assessment including; routine blood tests, ESR, CRP, RF, ANA, C4, cryoglobulins (CGs), anti-GM1 antibodies, HCV antibodies, Quantitative PCR, abdominal ultrasonography, liver biopsy, and electrophysiological assessment.ResultsThirty-six patients (45%) had clinical neuropathy, 18 patients (22.5%) had subclinical neuropathy. Thirty-eight out of the 54 PN patients (70.3%) showed axonal neuropathy which is mainly sensory affecting lower limbs. Twelve patients showed +ve cryoglobulinemia, all of them had neuropathy (10 clinical, 2 subclinical). Abnormal titers of anti-neuronal antibodies were associated with electrophysiological abnormalities in 50 out of the 54 PN patients. PN correlated with age, disease duration, ESR, CRP, RF, HCV viraemia, CGs, anti-GM1 and hypocomplementinemia.ConclusionsPN exists in high prevalence among Egyptian HCV patients, and is associated with CG. It is mainly of axonal sensory type more affecting lower limbs. HCV patients should be investigated for the presence of CGs even in the absence of clinical manifestations.
    Full-text · Article · Jul 2012 · Egyptian Rheumatologist
  • Source
    • "Fatigue was the most prevalent symptom associated with HIV/HCV co-infection in our study. This is consistent with other reports in HIV (Johnson et al., 2003; Justice et al., 2001) and HCV (Lorenz et al., 2001; Santoro et al., 2006) mono-infected samples. Among participants with very high quantitative symptom scores, descriptions of profound fatigue were the only commonality found in the qualitative data. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hepatitis C virus (HCV) infection has emerged as a major problem for adults with HIV infection. This report describes the symptom experience of HIV/HCV-coinfected adults at entry into a longitudinal mixed-method study. In-depth qualitative interviews and a standardized quantitative symptom measure were used to capture the symptom experiences of 39 (46% women) HIV/HCV-coinfected patients. Four major themes emerged from the qualitative interviews: (a) difficulty differentiating between HIV and HCV-related symptoms, (b) commonly cited HCV-related symptoms, (c) ways to control or manage HCV-related symptoms, and (d) lack of symptoms or tests to monitor HCV disease. Participants reported an average of 10 different symptoms and a mean symptom experience score of 18.33 (range = 2-47). Results show the significant symptom burden experienced by HIV/HCV-coinfected adults. However, results suggest that the prevalence of symptoms for HIV/HCV-coinfected patients may not be greater than those experienced by patients with HIV infection alone.
    Full-text · Article · May 2008 · Journal of the Association of Nurses in AIDS Care
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cryoglobulinemia may be found in a spectrum of disorders spanning clear-cut-B-cell neoplastic states, in which cryoprecipitation manifests as ischemic or occlusive vasculopathy, to a variety of immune complex diseases, in which vasculitis or glomerulonephritis may occur. Symptomatic cryoglobulinemia is many diseases, driven by and driving antibody-antigen responses, hepatic dysfunction, lymphoproliferation, and immune complexes. Distinguishing features that cause only some cryoglobulins to be symptomatic, elucidating the pathogenic mechanisms of HCV in cryoglobulin formation, and devising better therapies and more systematic evaluation of existing therapies are among the challenges for the future. Prognostication and classification will continue to rely on Brouet's classification (types I, II, and III), but additional features will probably include the presence or absence of HCV, HCV factors (genotype, titer), coexisting infections, B-cell clone burden, host factors, and immune system interactions (B- and T-cell idiotype networks, cytokines). Although antiviral therapy is a reasonable option for HCV-associated cryoglobulinemia, not all patients are HCV-positive, and only 60% to 80% of HCV-positive patients respond to IFN. In addition, not all patients tolerate IFN, and in those who do, the response is often short-lived once the treatment is discontinued. Only creative strategies, systematically studied, will provide long-awaited solutions.
    Preview · Article · Jan 2000 · Hematology/Oncology Clinics of North America
Show more