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
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by Spencer J, et al., involving 789 persons (as yet, unpublished)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.
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.
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.
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
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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