Gender differences in chronic HBsAg carriers in Italy: Evidence for the independent role of male sex in severity of liver disease

It has been shown that sexual hormones havean opposite effect on hepatic fibrosis progres-sion and hepatocellular carcinoma develop-ment. Sex differences among 2,762 chronicHBsAg carriers consecutively referring Italianhospitals in 2001 and in 2007 have beenevaluated, particularly focusing on the role ofgender on severity of liver disease. The over-all sex ratio (males/females) was 2.6. Femaleswere more likely born abroad and new diag-nosis cases; but less likely HIV coinfected. Nosex difference was observed regarding coin-fection with other hepatitis viruses. The sexratio linearly increased with increasing se-verity of liver disease, being 1.3 in normalALT, 2.8 in chronic hepatitis, 3.6 in livercirrhosis, and 6.8 in hepatocellular carcinoma.Adjustment by multiple logistic regressionanalysis for the confounding effect of age,alcohol intake, HDV infection, HCV infection,and BMI shows that male gender is anindependent predictor of the likelihood ofmore severe liver disease (O.R. 1.7; C.I.95%¼1.3–2.1). HBV-DNA levels resulted notassociated with the outcome of chronic HBVinfection. Despite some potential risk factorsassociated with liver disease, such as HBVgenotype or mutations, not having been con-trolled for due to lack of availability, theobserved sex disparity in the outcome ofchronic HBV infection may support biologicalobervation that HBV infection could be con-sidered a sex hormone–responsive virus