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Sex dictates liver disease risk in hepatitis B

Men with hepatitis B are at increased risk for severe liver disease compared with women; however, lifestyle and environmental related exposures cannot explain the sex differences, suggesting biological causes, according to data published in PLoS One.

“Previous studies have observed that, among hepatitis B chronic infection patients, males are more likely than females to develop and die from [hepatocellular carcinoma],” Jing Sun, PhD, a post-doctoral fellow at Johns Hopkins University, and colleagues wrote. “Some have speculated that the gender discrepancy may be due to lifestyle-related differences, since previous epidemiologic studies have shown that lifestyle-related exposures (eg, alcohol consumption and smoking habits) increased the risk of hepatocellular carcinoma in hepatitis B infected patients.”

Researchers examined whether lifestyle and environmental related exposures impacted the differences in liver disease severity observed between men and women infected with hepatitis B. Using data from 1,863 Chinese patients enrolled in the Haimen City cohort, Sun and colleagues categorized liver disease severity as normal, mild, moderate and severe based on clinical diagnosis. They reviewed patients’ questionnaires to measure lifestyle and environmental exposures, using factor analysis and individual variables to represent these exposures.

Analysis revealed that HBV-infected men were 2.08 times more likely to develop more severe liver disease compared with women (95% CI, 1.66-2.61). Men were also twice as likely as women to develop cirrhosis or liver cancer. Participants with HBV had a 2.19 times increased risk for developing more severe liver disease, regardless of sex, compared with non-infected participants (2.19; 95% CI, 1.61-2.96). Measuring for lifestyle and environmental exposures did not change these findings.

Researchers observed that current male drinkers were 8 times as likely to develop severe liver disease compared with women whose risk was 4 times as likely if they consumed alcohol. Smoking also increased the risk for developing liver disease, with men twice as likely to develop disease and women 6% more likely. Even when accounting for these disparities, sex was still the strongest independent indicator of liver disease risk in patients with HBV.

“Our study provided evidence to support the hypothesis that the gender effect on liver disease severity among [chronic hepatitis B] is not altered by the behavioral difference between males and females in a large Chinese population,” Sun and colleagues wrote. “These findings validated the observation in animal studies and other human populations, and it brings the focus of research on gender discrepancy in liver disease severity back to biological pathways.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.