REPLY:

Abstract

We thank Dr. Roy and Dr. Dhiman for the interest in our study. Their comments stressed two primary aspects regarding the management of patients with HCV chronic infection. On the one hand, it is important to underline the need of further studies, based on longer postantiviral treatment followups and conducted on large populations. This will allow us to ascertain whether demographic and anamnestic factors could help the prognostic approach to HCV cryoglobulinemic vasculitis (CV). On the other hand, the issue of a holistic view of patients with HCV was raised. A posttreatment flowchart taking into account more than hepatological problems would allow the best clinical management after viral eradication. In fact, previous analyses showed the impact of different aspects on HCV disease.(1,2) Concerning the other specific questions, targeted studies will be useful to evaluate weather decompensated cirrhosis or HCC cause a different disease outcome. In our study, the small number of patients with advanced liver damage or posttreatment liver cancer did not allow a statistical analysis. Similarly, dedicated analyses will assess the impact of directacting antivirals on the risk of developing HCV extrahepatic manifestations. In fact, previous studies showed that, among patients with HCV, the medium age of those with CV was significantly higher compared to the age of people without lymphoproliferative diseases.(3) We can now only speculate that, in the near future, the risk of HCVrelated lymphoproliferative disorders will decrease as a consequence of a shorter persistence of the infection in the host. Finally, we fully agree with the predictive importance of routine serological markers of mixed cryoglobulinemia. In our study, the rheumatoid factor (RF) levels were significantly higher in patients with a persistence/recurrence of CV compared to those who obtained a longlasting clinical response. This finding also has a pathophysiological meaning as RF molecules are produced by the same B cells whose clonal expansion is considered the basis of cryoglobulinemia.(4)