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March 16, 2005

Pegylated Interferon vs Standard Interferon for Chronic Hepatitis C—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(11):1323-1324. doi:10.1001/jama.293.11.1323-b

In Reply: Dr Menkes raises 2 issues not addressed in our study. The first concerns the correlation between the decrease in viral load and an attenuation of extrahepatic manifestations of HCV infection. This issue was beyond the scope of our trial, and the patients were not screened for cryoglobulinemia or rheumatoid factor. However, it is noteworthy that clinical extrahepatic manifestations of HCV infection were rare in our study participants (one patient had vasculitis and another had polyneuritis). This was probably due to the exclusion of patients with antinuclear antibodies at baseline. In previous studies of HIV-seronegative populations, we found that an HCV virological response was associated with a reduction in cryoglobulin levels and with an improvement in clinical extrahepatic manifestations.14 The question of such an association remains open in the HIV-coinfected population.

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