Liver fibrosis in women with chronic hepatitis C: evidence for the negative role of menopause and steatosis and the potential benefit of hormone replacement therapy

Liana Codes ¹, Tarik Asselah ², Dominique Cazals-Hatem ³, Florence Tubach ⁴, Dominique Vidaud ⁵, Raymundo Parana ¹, Pierre Bedossa ³, Dominique Valla ² and Patrick Marcellin ^2*

¹ Hepatology Unit, University of Bahia, Brazil
² Service d'Hépatologie & INSERM CRB3, University of Paris VII, Hôpital Beaujon, France
³ Service d'Anatomie Pathologique, Hôpital Beaujon, France
⁴ Département d'Epidémiologie, Hôpital Bichat, France
⁵ Service de Biochimie, Hôpital Beaujon, France

^* To whom correspondence should be addressed. E-mail: patrick.marcellin{at}bjn.ap-hop-paris.fr.

Accepted 30 August 2006

Abstract

Background/Aims: The rates of fibrosis progression in chronic hepatits C are signicantly different between males and females. The antifibrogenic effect of estrogen has been proposed, possibly via the inhibition of stellate cells. The aim of this study was to evaluate the severity of chronic hepatits C in women, according to menopause, steatosis and hormone replacement therapy (HRT).

Methods: From November 2003 to October 2004, women with chronic hepatits C were enrolled prospectively. A questionnaire was completed prospectively and a blood sample was obtained the day of biopsy. We identified characteristics associated with moderate/severe fibrosis by using univariate and multivariate analysis.

Results: Our study included 251 women. A total of 122 women (52 %) were menopaused and 65 received HRT. The 61 (24 %) women with moderate/severe fibrosis (F2-F4, Metavir score) had a longer known duration of infection (> 15 years), a higher BMI and presented steatosis more frequently than the 190 (76 %) women with mild fibrosis (F0-F1). Women with F2-F4 were more often menopaused (67 % versus 47 %). The probability of fibrosis F2-F4 was lower for menopaused women with HRT (p=0.012). Steatosis was more frequent and more severe in menopaused women.

Conclusions: Severity of fibrosis was associated with a longer duration of infection (> 15 years), a higher BMI, advanced steatosis and menopause. Menopaused women with HRT presented lower stage fibrosis. These results reinforce the hypothesis of a protective role of estrogens in the progression of fibrosis. Steatosis may be implicated in the progression of fibrosis after menopause.

Keywords: chronic hepatitis C, fibrosis, hormone replacement therapy, menopause, steatosis

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