title: Effect of Gender on the Response to Hepatitis C Treatment in an Inner-City Population.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the United States. Response to treatment has improved with the addition of direct acting protease inhibitors. However, there are limited real-world data on the role of gender in achieving a sustained virologic response (SVR).
  
  
  METHODS
  We conducted a cross-sectional study in 70 patients treated for HCV, genotype 1 infection with pegylated alpha interferon, ribavirin, and either telaprevir or boceprevir at our inner-city liver clinic.
  
  
  RESULTS
  The SVR was significantly lower in women than in men (24% vs. 59%; p < .01). Statistical significance persisted after adjusting for age, race, genotype, prior treatment status, duration of therapy, and stage of fibrosis. The adjusted odds ratio for achieving SVR was significantly lower in women than in men (odds ratio [OR], 0.13; 95% CI, 0.03-0.58; p = .01). Relapse after completing treatment was more likely to occur in women (p = .02). Thirty-four patients (48%) did not complete therapy. Discontinuation because of loss to follow-up was more likely in women, whereas discontinuation owing to therapy limiting adverse drug events were more common in men. Discontinuation rates owing to failure of therapy were similar in men and women.
  
  
  CONCLUSIONS
  There was a significant difference in SVR between men and women. Both biological and nonbiological factors, the latter including access to care, adherence to therapy, and attitudes of and toward health care providers all could play a role in contributing to the observed disparity between sexes in treatment response.
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York.
authors.forename: Priya
authors.initials: P
authors.lastname: Simoes
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York.
authors.forename: Adel
authors.initials: A
authors.lastname: Asaad
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York.
authors.forename: Jean
authors.initials: J
authors.lastname: Abed
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Engelson
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York. Electronic address: dkotler@chpnet.org.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Kotler
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009518:New York; D009842:Oligopeptides / Q000627:therapeutic use*; D011204:Poverty Areas; D012111:Residence Characteristics; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014505:Urban Population; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D012254:Ribavirin; C486464:telaprevir