Gender Disparity in Hepatitis: A New Task in the Challenge Against Viral Infection

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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 [1-4]. 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) [6]. 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 [7,8]. 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 [9] 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 [11], 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 [12,13]. Both these viral factors probably contribute to the increased risk to develop HCC in male with respect to female.