title: Gender differences in chronic HBsAg carriers in Italy: Evidence for the independent role of male sex in severity of liver disease.
abstract: It has been shown that sexual hormones have an opposite effect on hepatic fibrosis progression and hepatocellular carcinoma development. Sex differences among 2,762 chronic HBsAg carriers consecutively referring Italian hospitals in 2001 and in 2007 have been evaluated, particularly focusing on the role of gender on severity of liver disease. The overall sex ratio (males/females) was 2.6. Females were more likely born abroad and new diagnosis cases; but less likely HIV coinfected. No sex difference was observed regarding coinfection with other hepatitis viruses. The sex ratio linearly increased with increasing severity of liver disease, being 1.3 in normal ALT, 2.8 in chronic hepatitis, 3.6 in liver cirrhosis, and 6.8 in hepatocellular carcinoma. Adjustment by multiple logistic regression analysis for the confounding effect of age, alcohol intake, HDV infection, HCV infection, and BMI shows that male gender is an independent predictor of the likelihood of more severe liver disease (O.R. 1.7; C.I. 95% = 1.3-2.1). HBV-DNA levels resulted not associated with the outcome of chronic HBV infection. Despite some potential risk factors associated with liver disease, such as HBV genotype or mutations, not having been controlled for due to lack of availability, the observed sex disparity in the outcome of chronic HBV infection may support biological observation that HBV infection could be considered a sex hormone-responsive virus.
authors.affiliation: Department of Tropical and Infectious Diseases, University of Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Stroffolini
authors.affiliation: Department of Tropical and Infectious Diseases, University of Rome, Italy.
authors.forename: Rozenn
authors.initials: R
authors.lastname: Esvan
authors.affiliation: Department of Tropical and Infectious Diseases, University of Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Biliotti
authors.affiliation: Department of Public Medicine, Infectious Diseases Unit, Second University of Naples, Caserta CE, Italy.
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.affiliation: Department of Internal and Specialized Medicine, Second University of Naples, Caserta CE, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Gaeta
authors.affiliation: Department of Gastroenterology, University of Palermo, Italy.
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: Chronic HBsAg carriers; cirrhosis; hepatocellular carcinoma; sex differences