Gender/sex-specific medicine is still a neglected field of
investigation, which is devoted to the analysis of the disparity between men
and women in disease pathogenesis and prevention, in the detection of clinical
signs or symptoms, in the prognosis and response to therapy as well as in
psychological and social determinants of morbidity. For instance, it is well
documented that incidence and outcome of several human diseases, such as
cardiovascular diseases, tumors, degenerative diseases, or some respiratory and
neurological disorders display a significant disparity between males and
females. In addition, it is now emerging that men and women also
experience a different susceptibility to some virus infections, often with a
different outcome. In addition, even the prevention or the response to
antiviral treatments can display significant differences between male and
female patients.
Hepatitis B (HBV) and C viruses (HCV) are responsible of chronic
liver disease and are the major risk factors for development of hepatocellular
carcinoma (HCC). It is estimated that 240 million people worldwide are
chronically infected with HBV and at risk of serious illness, like cirrhosis
and HCC. One hundred seventy million people are estimated to be chronically
infected with HCV, whose infection prevalence is about 3% in the developed
countries whereas, only in Europe, about 4 million people are HCV carriers. Beside these epidemiological data, sex disparity in the natural history
of HBV and HCV infections and in the evolution and progression of the
associated liver disease in different geographic areas of the world have
been reported since many.
A number of studies are available regarding
gender differences in HBV infection, whereas HCV infection appears studied in
less detail. After the initial knowledge that men are more likely than women to
become chronic carriers for HBV, it has been recognized that the serum
prevalence of HBV surface antigen (HBsAg) and the DNA virus titers are higher
in serum of men than women. Both these viral factors probably
contribute to the increased risk to develop HCC in male with respect to female.
In fact, the male/female ratio for HCC prevalence has been reported to be from
2:1 to 4:1. Due to the close interaction between virus and host, both host
and viral mechanisms could be responsible of this gender disparity in HBV
infection and disease progression.
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