Telbivudine in the treatment of hepatitis B-associated cryoglobulinemia

Background: Hepatitis C virus (HCV) infection is often associated to extrahepatic manifestations while these are less common in HBV infections. Reported cases of mixed cryoglobulinemia (MC) related to HBV infection are very rare: the exact prevalence of this extrahepatic manifestation has not yet been established and the optimal treatment is unclear (no guideline indications are available). Objectives: We propose an explorative evaluation of treatment of MC HBV-related with telbivudine (LdT) in a small group of patients affected by chronic hepatitis B (CHB). Study design: We included 7 patients affected by CHB naive for previous treatment. We administered a single dose of 600. mg/day of LdT. ALT levels, HBV-DNA, CD4+/CD8+ ratio and cryocrit were monthly measured. We evaluated the efficacy of 1 year-treatment with LdT on the cryocrit and MC-related symptoms. Results: We observed a significant decrease of cryocrit (. p=. 0.002) and HBV-DNA (. p=. 0.001) during the treatment; CD4+/CD8+ ratio increased (. p=. 0.002) after 1 year. Five patients did not show symptoms and two patients with necrotizing vasculitis have reported a significant clinical improvement with only residual paresthesias. No exacerbations were observed. Conclusions: We consider LdT a suitable option for the treatment of MC HBV-related.