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Mixed Cryoglobulinemia in HIV-1 Infection: The Role of HIV-1

Antonios N. Dimitrakopoulos, MD; Theodore Kordossis, MD; Angelos Hatzakis, MD; and Haralampos M. Moutsopoulos, MD
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From National and Kapodistrian University, Athens, Greece.


Ann Intern Med. 1999;130(3):226-230. doi:10.7326/0003-4819-130-3-199902020-00027
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Background: Cryoglobulins are associated with chronic infections.

Objective: To investigate the prevalence of mixed cryoglobulinemia in patients with HIV-1 infection, the clinical spectrum of cryoglobulinemia in these patients, and the possible role of HIV-1 in cryoglobulin formation.

Design: Prospective cohort study.

Setting: Laiko Hospital, Athens, Greece.

Patients: 89 patients with HIV-1 infection.

Measurements: Serum and cryoglobulins were evaluated for antibodies to HIV and hepatitis C virus (HCV), HIV-1, and HCV viral load.

Results: Mixed cryoglobulins were detected in 24 patients with HIV-1 infection (27% [95% CI, 18% to 36%]). The HIV-1 viral load was higher in cryoglobulin-positive patients (median, 38.25 × 103 copies/mL [25th, 75th percentiles: 13.8 × 103 copies/mL, 78.55 × 103 copies/mL]) than in cryoglobulin-negative patients (median, 5.3 × 103 copies/mL [25th, 75th percentiles: 0.7 × 103 copies/mL, 27.2 × 103 copies/mL]) (P = 0.001). Antibodies to HIV were detected in all cryoprecipitates, and HIV-1 RNA sequences were identified in 22 of the 23 cryoprecipitates examined. Nine cryoglobulin-positive patients (38% [CI, 19% to 54%]) had clinical manifestations compatible with cryoglobulinemia.

Conclusions: Mixed cryoglobulinemia is common in patients with HIV-1 infection.

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