Mixed cryoglobulinemia in HIV-1 infection: The role of HIV-1

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 x 10(3) copies/mL [25th, 75th percentiles: 13.8 x 10(3) copies/mL, 78.55 x 10(3) copies/mL]) than in cryoglobulin-negative patients (median, 5.3 x 10(3) copies/mL [25th, 75th percentiles: 0.7 x 10(3) copies/mL, 27.2 x 10(3) 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.