Source: Abstract #SAT-201 Gender differences on long-term outcomes in patients with dual chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infection—S. Shah, et al.
Study Aims and Results: Male gender is a proven risk factor among those with chronic mono HCV infection to develop end-stage liver disease and liver cancer (hepatocellular carcinoma or HCC). What is unclear is if any gender differences persistently exist among patients with dual HBV/HCV infection. This study investigated the occurrence of cirrhosis, hepatic decompensation and HCC in HBV/HCV dual infected individuals. 239 men and 120 women with HBV/HCV infection that were seen from 1999 through 2015 at U.S. tertiary care centers were evaluated for this study. Subject’s medical records yielded laboratory values, imaging results and necessary treatment information. The main outcomes were the 10-year occurrence of cirrhosis, hepatic decompensation and HCC. The demographic breakdown is as follows: 41% White, 31% Asian, 15% Hispanic and 13% identified as Other. The mean age was 55.2 with a plus or minus of 10.9 years among men and 56.8 with a plus or minus of 13.1 among women. There was no baseline gender difference in HCV viral load or level of liver scarring, however, men did have higher rates of alcohol and tobacco use, as well as diabetes, lower number of blood clotting agents and were more likely to present with HCC than women. The 10-year occurrence of cirrhosis in individuals without baseline cirrhosis was high yet similar across genders. Despite this, men were significantly more likely to develop HCC. The occurrence of HCC in men and women was 101.6 (men) and 57.8 (women) per 1,000 person years. This means that 101.6 and 57.8 cases would be expected in a given year among HBV/HCV dual infected people. The 10-year total HCC occurrence was 37% among men and 17% among women. Men also showed a higher total trend of a 10-year occurrence in hepatic decompensation than women.
Conclusion: The occurrence of cirrhosis and HCC was high in both men and women with HBV/HCV dual infection. Still, men showed a significantly higher risk for HCC. There also were no gender differences in the occurrence of cirrhosis development.
Editorial Comments: This study showed the importance of early antiviral therapy among HBV/HCV dual infected individuals. An approach of early treatment intervention among this group will help prevent long-term complications. A focus on those who are at a higher risk is especially important. Testing for HBV upon HCV diagnosis is key to this approach as well. This study shows the potentially negative outcomes of failing to address HBV/HCV dual infection among both men and women while underscoring the significant risk posed to men who go untreated.
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