Gender specific medicine in liver diseases: A point of view

Table 1 Gender differences in primary biliary cirrhosis and autoimmune hepatitis

Primary biliary cirrhosis	Autoimmune hepatitis
M/F ratio 1:10	M/F ratio 1:3.6
Age at diagnosis higher in M than in F (62 yr vs 51 yr)	Normalization of ALT levels after 6 mo of corticosteroid treatment less frequent in M than in F
M less symptomatic than F: pruritus, abdominal pain/discomfort and constitutional symptoms more common in F; jaundice and upper gastrointestinal bleeding more common in M	Better long-term survival and outcome in M than F
Concomitant autoimmune diseases more common in F (sicca syndrome, sclerodermia, raynaud phenomenon), whereas HCC complication are significantly greater in M	Decrease of severity during second trimester of pregnancy and possible onset of acute exacerbation after delivery
ALP, ALT and gGT higher in M than F	Haplotype HLA A1-B8-DR3 more prevalent in M than in F
Piecemealnecrosis and pseudoxanthomatous	Higher frequency of concurrent immunological
trasformation greater in symptomatic F	disorders at presentation in F than M

HCC: Hepatocellular carcinoma; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; gGT: Gamma-glutamyl transpeptidase; HLA: Human leukocyte antigen; F: Female; M: Male.

Table 2 Gender differences in alcoholic liver disease

Alcoholic liver disease (hepatic steatosis, alcoholic hepatitis, cirrhosis)
Hepatic damage faster in F than M
RR to develop cirrhosis 7 in M and 17 in F
RR to develop alcoholic liver disease 3, 7 in M and 7, 3 in F
F more susceptible to damage by alcohol than M: higher haematic concentration of ethanol in F than M: major risk of hepatitis progression toward cirrohosis (even after an absentation from alcohol) in F than M
Differences in corporal structures (content of corporal water), different enzymatic activity (gastric ADH expression and activity), hormonal

ADH: Alcohol dehydrogenase; RR: Relative risk; F: Female; M: Male.

Table 3 Non alcoholic fatty liver disease and gender

NAFLD and gender
Prevalence of MS in men and postmenopausal women
Prevalence of visceral adiposity in men and postmenopausal woman
Possible link to MS, NAFLD and sex hormones

NAFLD: Non alcoholic fatty liver disease; MS: Metabolic syndrome.

Table 4 Chronic hepatitis B during the pregnancy and in the foetus

HBV and pregnancy	HBV and foetus
Not increases in maternal morbidity and mortality	Maternal transmission: during delivery, intrauterine transmission and during breast feeding
Increases HBV viremia levels and indices of cytolysis	Discordant results from pre-delivery administration of Ig and anti-HBV vaccine
Development of complications (gestational diabetes, pre-delivery hemorrhages and pre-term delivery)	Administration of Ig and anti-HBV vaccine during delivery to prevent infection
Higher frequency of gestational hypertension, detachment of placenta and peripartum hemorrhages in F with cirrhosis Cases of peripartum hepatitis with hepatic decompensation	Ongoing studies about the use of antiviral medicines in F with high HBV DNA levels to prevent perinataltransmission (telbivudine and tenofovir in FDA pregnancy category B)

HBV: Hepatitis B virus; F: Female; FDA: Food and drug administration.

Table 5 Chronic hepatitis C during the pregnancy

Chronic hepatis C and pregnancy
Frequency of HCV MTCT is 5%-10%
Vertical transmission is the main cause of pediatric HCV infection
Factors increasing the risk of MTCT: amniocentesis, extended breaking of the membranes and elevated viral load in the mother
High levels of ALT in the previous year of pregnancy are linked with a higher MTCT rate
Signs of viral replications is maternal peripheral blood mononuclear cells enhance vertical transmission
Breastfeeding and genotype are not linked to MTCT
Presence of HCV-HIV coinfection increases MTCT by 90%
The administration of combined therapy is not recommended during pregnancy

HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; MTCT: Mother-to-child transmission; ALT: Alanine aminotransferase.