Menopause Linked to Poor Hepatitis C Treatment Response
Women who enter menopause early have worse liver disease
but are less likely to achieve sustained response to
interferon-based therapy for chronic hepatitis C.
Experts have long recognized sex differences in response to therapy
for chronic hepatitis C virus (HCV)
infection. Women as a group tend to experience less aggressive
liver disease progression and respond to treatment better than
men; research indicates that estrogen influences these outcomes.
Less is known about how hormonal changes at menopause might affect
described in the March
2011 issue of Gastroenterology, Erica Villa and colleagues
from Italy looked at associations between menopause, damage, and
sustained virologic response (SVR).
The investigators conducted a prospective study of 1000 consecutive
treatment-naive patients age 18 and older with compensated liver
disease due to chronic hepatitis C; 442 participants (44%) were
The research team examined liver biopsy samples for fibrosis,
inflammation, and steatosis (fat accumulation) before patients
started standard therapy consisting of pegylated
interferon plus ribavirin.
Women provided data about timing and characteristics of their
menopause. The researchers evaluated relevant hormonal and metabolic
parameters and measured levels of interleukin-6 (IL-6) in the
blood and tumor necrosis factor alfa (TNF-a) in the liver.
women achieved SVR significantly less often than women of
reproductive age (46.0% vs 67.5%, respectively; P < 0.0001).
women had a sustained response rate more similar to that of
men (46.0% vs 51.1%; P = 0.283).
a multivariate analysis controlling for other factors, significant
independent predictors for failure to achieve SVR included:
menopause: odds ratio 8.05;
levels of gamma-glutamyl transpeptidase: odds ratio
genotype 1 or 4 (vs 2 or 3): odds ratio 3.86;
cholesterol levels: odds ratio 0.99.
women with hard-to-treat HCV genotype 1, early menopause was
the only independent factor that predicted lack of SVR (odds
In addition, biopsies showed that post-menopausal women had
significantly worse liver inflammation, fibrosis, and steatosis
than women of reproductive age, as well as higher IL-6 and
on these findings, the study authors concluded, "Among women
with chronic hepatitis C, early menopause was associated with
a low likelihood of SVR, probably because of inflammatory factors
that change at menopause."
affiliations: Department of Gastroenterology, University of Modena
and Reggio Emilia, Modena, Italy; Department of Gastroenterology,
University of Palermo, Italy; Department of Gastroenterology,
University of Bari, Italy; Department of Gastroenterology, AUSL,
Modena, Italy; Department of Infectious Diseases, University of
Rome "La Sapienza," Rome, Italy; Department of Internal
Medicine, University of Pisa, Italy.
Villa, A Karampatou, C Camma, and others. Early Menopause Is Associated
With Lack of Response to Antiviral Therapy in Women With Chronic
Hepatitis C. Gastroenterology 140(3): 818-829 (abstract).