Gender difference and hepatitis C


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Gender difference and hepatitis C
By Paul Harvey

Like most viruses, the hepatitis C virus fundamentally does not discriminate. Although there are slight nuances and trends, it infects women just as easily as men - and it will generally have a similar effect on people's health, be they male or female.

Prevalence and incidence trends
Up to the end of 1997, over 110,000 notifications had been reported in Australia. A gender trend has emerged with close to twice as many males as females returning positive HCV antibody tests.
In contrast, information from an ongoing study involving around 20 Australian needle and syringe programs suggests a higher prevalence of HCV among women (MacDonald M, et al. MJA 17 Jan 2000;172 57-61). This trend is most pronounced among young people (15-24 years).
A relatively high hepatitis C prevalence among young women who inject drugs may be related to sharing with older male partners - who have been injecting longer.
However, the number of men responding to the survey was more than double that of women suggesting more men inject drugs than women which may explain the gender bias of overall notifications (top).

A 1996 study involving 96 persons (Love A, et al. American Journal of Epidemiology, 143, 6:631-636) suggested that significantly fewer females than males had detectable HCV viral RNA in their blood [were PCR positive]. The researchers believed that women eliminate the hepatitis C virus more effectively than men.
Larger studies, however, do not support this belief. A recent study by Spencer J, et al., involving 789 persons (as yet, unpublished) found that factors such as gender, age, ethnicity or drug taking habits were not important predictors of infectiousness. Further studies may shed more light on this area.

Illness outcome
Some recent studies have suggested a slower progression of hepatitis C liver damage in women, (see recent study by Roudot-Thoraval F, et al. Hepatology, 26:485-490). Supporting this suggestion is Australian research showing that liver cancer is generally more common in men than in women whether due to hepatitis C or other causes (Khan M, et al. Hepatology, 31:513-520). The reasons why hepatitis C (and many other diseases) may be different in women than in men are unclear, although research is starting to unravel an interesting sex difference between the way in which males and females develop scarring of the liver.

Hormonal effects
Although both men and women use products such as growth hormones, this issue primarily relates to women, specifically in regard to menstrual cycle and menopause.
In most cases, women's menstrual cycles are not affected by hepatitis C virus. Should irregularities occur, general practitioners or women's health practitioners can provide a health checkup to clarify if other health problems are involved.
It is believed that women with quite serious liver damage may experience intolerance to the oestrogen based contraceptive pill or hormone replacement therapy. General practitioners, endocrinologists [hormone specialists] or women's health practitioners should be able to provide advice in this area.

Treatment response
People are taking up antiviral treatment at a similar gender ratio to HCV notifications - roughly 2 men for every 1 woman (National Hepatitis C Database Project, 1999).
It is generally acknowledged that complex interplays between genotype, viral load, age at acquisition of HCV, alcohol use and present level of fibrosis [liver inflammation] play the primary roles in determining antiviral treatment outcome (Sievert W, Korevaar D. Aust Fam Physician 1999;28 SI40-45).
One small study has suggested, though, that in addition to the above, more commonly mentioned factors, male gender, racial background and post-menopausal state for women (oestrogen &/or progesterone) are associated with a lower probability of responding to interferon-based therapy (Colantoni A, et al. Antiviral Therapy 1999; 4 Supplement 4, 38). Future studies may confirm what effect gender and hormone levels have on determining treatment outcome.

Paul Harvey is Special Projects Officer at the Hepatitis C Council of NSW.
Thanks to Dr Greg Dore, National Centre in HIV Epidemiology and Clinical Research, for editorial assistance.

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