Chronic Liver Diseases Develop More Slowly in Females Than Males

More than 350 million and 170 million people worldwide are persistently infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. Chronic HBV infection is the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the world, while HCV infection is the main cause of cirrhosis and HCC in Japan, Europe, and the United States. Cirrhosis and HCC are predominantly diseases which tend to occur in men and postmenopausal women. Differences in the social environment and the lifestyles of women and men may be involved in the basic mechanisms underlying the sex-associated differences in progression of HCV and HBV infection. In general, males have a greater risk of exposure to hepatitis viruses as well as a greater opportunity for drinking. Environmental factors may result in a higher preponderance of nutritional and exercise-associated problems in males. Females, particularly before menopause, could produce antibodies against HBV surface antigen and e antigen at a higher frequency than males among HBV carriers. The progression time from chronic hepatitis C to cirrhosis is found to be longer in females than in males. Male sex, older age (≥50 years) and cirrhosis are important host-related risk factors for the development of HCC. Therefore, cases of female sex and under 50 years old, namely “premenopausal women” are least vulnerable to HCC.

Keywords: Sex-associated difference, male predominance, menopause, sex hormone, male-to-female ratio, HBV, HCV, hepatocellular carcinoma, cirrhosis, environment, lifestyle, drinking, slow progression