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

Abstract

Background and aims: The rates of fibrosis progression in chronic hepatitis C are significantly different between males and females. The antifibrogenic effect of oestrogen has been proposed, possibly via inhibition of stellate cells. The aim of this study was to evaluate the severity of chronic hepatitis C in women, in relation to the menopause, steatosis and hormone replacement therapy (HRT). Methods: From November 2003 to October 2004, women with chronic hepatitis C were enrolled prospectively. A questionnaire was completed prospectively and a blood sample was obtained on the day of biopsy. We identified characteristics associated with moderate/severe fibrosis using univariate and multivariate analysis. Results: 251 women were included in the study. 122 women (52%) were menopausal and 65 were receiving HRT. 61 (24%) women with moderate/severe fibrosis (F2-F4, Metavir score) had a longer known duration of infection (.15 years), a higher body mass index and presented with steatosis more frequently than 190 (76%) women with mild fibrosis (F0-F1). Women with F2-F4 were more often menopausal (67% v 47%). The probability of fibrosis F2-F4 was lower for menopausal women receiving HRT (p = 0.012). Steatosis was more frequent and more severe in menopausal women. Conclusions: Severity of fibrosis was associated with a longer duration of infection (.15 years), a higher body mass index, advanced steatosis and the menopause. Menopausal women receiving HRT presented with a lower stage fibrosis. These results reinforce the hypothesis of a protective role of oestrogens in the progression of fibrosis. Steatosis may be implicated in the progression of fibrosis after the menopause.

Nonalcoholic Fatty Liver Disease in Menopausal Women

“…The relevance of HRT in patients with CHC was also evaluated by Codes et al (4) who observed that steatosis was more common and severe in menopausal women. Moreover the presence of liver fibrosis was lower among the women who referred HRT use (4) .…”

“…The relevance of HRT in patients with CHC was also evaluated by Codes et al (4) who observed that steatosis was more common and severe in menopausal women. Moreover the presence of liver fibrosis was lower among the women who referred HRT use (4) . Shimizu and Ito (19) also evaluated patients with CHC and observed a beneficial effect of estradiol on the progression of chronic liver disease.…”

“…A hepatic anti fibrogenic effect of HRT has also been referred in menopausal patients using HRT with the diagnosis of chronic hepatitis C (4) , and there are evidences of less hepatic injury during pregnancy in women with chronic hepatitis C (9) , pointing to an antifibrogenic effect of endogenous estrogen. The relevance of HRT in patients with CHC was also evaluated by Codes et al (4) who observed that steatosis was more common and severe in menopausal women.…”

Significance of serum leptin and adiponectin levels in Egyptian patients with chronic hepatitis C virus associated hepatic steatosis and fibrosis

“…Indeed, HCV quantity is not an independent predictor of pathology [47] . Finally, we measured total serum leptin levels (which is composed of free and protein-bound components) and total serum adiponectin levels (which is composed of three forms); so, we cannot exclude the beneficial role(s) for measurement of these specific components for each one [1,49] .…”

“…In addition, circulating adiponectin concentrations may also be affected by renal clearance, as adiponectin levels are elevated in states characterized 78 February 27, 2013|Volume 5|Issue 2| WJH|www.wjgnet.com by impaired renal function, such as macroalbuminuria [45] . We include only male patients in our study for two reasons: firstly, it is known that serum leptin and adiponectin levels are higher in females than males [27,46] ; secondly, to avoid the confirmed negative role of menopause on steatosis, and the potential benefit of hormone replacement therapy on hepatic fibrosis in HCV patients [47] .…”