Impact of Gender Difference on Characteristics and Outcome of Chronic Hepatitis C

Abstract

Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CHC, disease progression, and outcome after oral direct acting antiviral (DAA) therapy. The study was conducted at Tropical Medicine and Gastroenterology Department, Sohag University, Egypt, in the period between 2018 and 2020. 775 patients were evaluated for hepatitis C virus (HCV) risk factors. Laboratory investigations, abdominal ultrasound and liver Shear wave elastography (SWE) were done. The patients were given antiviral therapy and followed up to assess the response and side effects of DAA therapy. 434 (56%) of study patients were males and 341 (44%) were females. Catching infection from blood transfusion and intravenous (IV) injection of tarter emetic was significantly higher in males, while catching infection from surgical operation was significantly higher in females. Hepatic fibrosis was significantly more extensive in males. Side effects were reported more in females. Sustained virological response (SVR) 12 was reported in 98.6%. Females had a slightly better SVR12 than males (99.4% versus 97.9%). In conclusion males were different from females in exposure to HCV risk factors. After introduction of blood screening and stoppage of parenteral anti-bilharzial therapy the risk of HCV infection could be greatly prevented in males, while the exposure of females to obstetric procedure is increasing nowadays which hides a risk of ongoing infection in females. So, HCV surveillance programs in females retain their importance in early detection and management of CHC. Although hepatic fibrosis progression was more in males, females were more liable to adverse events of DAA therapy. So, researchers should consider the gender of their patients in drug design and administration.

Sex‐related difference analyses of efficacy and safety in clinical trials of direct‐acting antivirals to treat chronic HCV genotype 1 and 3 infections

“…Similar findings were seen in other studies. 15,[29][30][31] In the literature, reports of sex differences in the treatment of HCV GT3 are limited. The HCV-TARGET study 32 evaluated HCV GT 3 participants receiving sofosbuvir and ribavirin with or without peginterferon and found male sex was a negative predictor of SVR.…”

“…Numerically or statistically significantly higher SVR rates were observed in females treated with PEG‐INF and ribavirin 13,14 compared to males and overall females reported more adverse events. With more effective combination DAA regimens, females had a slightly higher SVR12 rate compared to males (99.4% vs 97.9%) in a recent observational study 15 . More side effects were reported in females compared to males and fatigue and GI upset events were significantly higher in females 10 …”

“…With more effective combination DAA regimens, females had a slightly higher SVR12 rate compared to males (99.4% vs 97.9%) in a recent observational study. 15 More side effects were reported in females compared to males and fatigue and GI upset events were significantly higher in females. 10 Notably, appreciable differences in SVR12 rates between sexes were not observed in individual trials evaluated by the FDA.…”

Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis

“…On the other hand, some studies found gender differences are artifactual, with nearly flat rates of HCV infection 12 – 15 . Also, some studies found a decreased rate of liver cirrhosis and hepatocellular carcinoma (HCC) in females 16 , more progress to hepatic fibrosis in males, and more liability to adverse events of direct-acting antivirals (DAAs) in females 17 .…”

Gene Sequencing of Hepatitis C Virus Isolated from Patients with Liver Diseases

“…6 The scale of these enzymes is classically used to provide information about viral hepatitis infections if the main disorder is biliary hepatitis, and knowing the percentage of enzymes in the sera of infected people, as well as knowing the patterns, provides abundant information for diagnosing the pathological condition. 7,8 There are multiple blood abnormalities accompanying chronic viral hepatitis, such as iron deficiency anemia, 9 which are frequent complications of chronic liver diseases. These are caused by many factors, including chronic bleeding in the digestive system.…”