HCV & Gender

By: Marcus Hopkins, Blogger

In the course of discussing the health risks associated with infectious disease, health care professionals often speak in broad terms – the basic symptoms of the disease; how the disease impacts the human body – but what is not as often discussed is how diseases differently affect members of the opposite sex.

As modern society moves closer to social equality between the sexes, what often gets lost in the pursuit of gender equality is the very real role that biology and human physiology plays in differentiating the sexes in terms of how their bodies react to various diseases and medications.

Gender Differences

There are several ways in which Hepatitis C (HCV) differently affects members of the opposite sex, many of which can play key roles in determining which populations should be more closely monitored over the course of the next decade as we approach treating and hopefully eradicating the burgeoning HCV epidemic.

Cirrhosis (scarring of the liver), for example occurs in 5%-20% of people with chronic HCV, according to the U.S. Centers for Disease Control and Prevention. Women, however, appear to be less susceptible to liver cirrhosis than men. Scientists believe that the female hormone estrogen is responsible for this extra protection, but that protection very likely dissipates as women age and enter into menopause, when estrogen production lessens.

As HEAL Blog is primarily concerned with HIV/HCV co-infection, this presents an excellent opportunity for advocacy to the HIV-positive community, as males represent a majority of the HIV-positive population. As such, reaching out to males who are HIV-positive is of particular importance in helping to ensure that information about HCV is adequately disseminated.

Another phenomenon that favors females is the incidence of “spontaneous clearance” – when the body is able to rid itself of a virus or infection without the aid of medication. Of those who are infected with HCV, an estimated 15% are able to avoid the potential ravages of chronic HCV infection. This clearance rate is higher in women than men, and once again, it is thought that estrogen plays a significant role in this difference.

While these two advantages favor females in how HCV impacts the human body, there are several reasons why women should be no less vigilant than men in aggressively screening and treating HCV.

As we have stated in previous postings, HCV is inefficiently spread through sexual contact. Like HIV, HCV is more efficiently spread through anal penetrative sex than vaginal, because of the greater risk of blood exposure. Women, however, are at greater risk of exposing their sexual partners when they are menstruating due to the presence of menstrual blood.

Additionally, women who gave birth via Cesarean delivery (C-Section) prior to 1992 (when testing for HCV began) and received blood transfusions during the process faced a greater risk of exposure during the process. As such, it is suggested that women who underwent this procedure be screened for HCV infection.

Ribavirin, one of the primary drugs used to treat HCV infection, has a common side effect: Anemia – low red blood cell count. Women are naturally more likely than men to develop Anemia, specifically because, unlike men, they experience menstruation causing a heavy loss of blood in the process. It is recommended that women who are prescribed Ribavirin frequently monitored their blood cell levels, as a result.

As women age, Hormone Replacement Therapy (HRT) is often used to increase the levels of estrogen to counteract the decreased production levels caused by menopause. Estrogen replacement pills, including oral contraception, are generally fine for women with HCV; however, women with significant or severe liver damage should not take these pills, because their livers may not be able to break down these hormones, and should consult with their physicians before beginning any estrogen replacement regimens.

HCV infection is a serious issue for both men and women, alike, but recognizing the differences in how HCV affects the sexes is an important step in addressing the looming crisis that faces our nation.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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