Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

Wellcome Open Research

article

Robin Brown¹  Philip Goulder²  Philippa C. Matthews¹ 

[1] Harris Manchester College, University of Oxford;Department of Paediatrics, University of Oxford;The Francis Crick Institute;Division of Infection and Immunity, University College London;Department of Infectious Diseases, University College London Hospital

关键词: hepatitis;    HBV;    sex;    gender;    oestrogen;    testosterone;    androgen;    cancer;    hepatocellular carcinoma;    gender;    stigma;    epidemiology;    outcome;    treatment;    dimorphism;   

DOI  :  10.12688/wellcomeopenres.17601.3

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV). HBV is a substantial global health problem, with close to 300 million people chronically infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, and consider how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.

【 授权许可】

CC BY