الفهرس 
The effect of sofosbuvir on cryoglobulinemic vsculitis
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Abstract
Cryoglobulinemic Vasculitis (CV) is a systemic vasculitis affecting small and medium-sized vessels. CV is triggered by hepatitis C virus (HCV). Sofosbuvir (Sovaldi), an NS5B polymerase inhibitor, is one of the Direct Acting Antivirals (DAAs), used for the treatment of chronic HCV.Objectives: Assess the effect of Sofosbuvir on Cryoglobulinemic Vasculitis. Methods: Our study included 34 HCV-CV patients fulfilling the newly validated international classification criteria and were treated by one of the approved protocols by the national committee for treatment of Hepatitis C virus in Egypt. Our patients were assessed regarding: Clinical manifestations, disease activity and laboratory investigations. Results: All patients showed a sustained viral response (SVR). Clinical manifestations significantly improved at the end of treatment (EOT) including constitutional manifestations (85.3%), skin purpura (100%), arthralgia (76.5%) and peripheral neuropathy (67.6.5%). Serum levels of cryocrit, rheumatoid factor and complement 4 significantly improved at EOT (85.2%, 82.3% and 73.5%; P value <0.001, <0.001 and 0.005 respectively). There is a statistical significant improvement in Birmingham Vasculitis activity score 3 (BVAS 3) with p-value <0.001. After 12 months from the start of antiviral therapy, in 23 patients, regardless the treatment protocol, articular and constitutional manifestations as well as cryocrit response showed significant deterioration (P value: 0.009, 0.006 and 0.002 respectively) despite sustained viral response after 24 weeks (SVR 24). There was a statistical significant over-expression of B cell-activating factor (BAFF) and A proliferation-inducing ligand (APRIL). There was also over-expression of DNA breaks and DNA repair genes at EOT