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. 2025 Jun 27;17(6):105899.
doi: 10.4254/wjh.v17.i6.105899.

Sex-related differences in patients with chronic hepatitis C infection treated with direct-acting antiviral drugs

Krystyna Dobrowolska  1 , Dorota Zarębska-Michaluk  2 , Malgorzata Pawłowska  3 , Magdalena Tudrujek-Zdunek  4 , Beata Lorenc  5 , Hanna Berak  6 , Ewa Janczewska  7 , Włodzimierz Mazur  8 , Justyna Janocha-Litwin  9 , Jakub Klapaczyński  10 , Marek Sitko  11 , Dorota Dybowska  3 , Anna Parfieniuk-Kowerda  12 , Anna Piekarska  13 , Jerzy Jaroszewicz  14 , Robert Flisiak  12
Affiliations

Sex-related differences in patients with chronic hepatitis C infection treated with direct-acting antiviral drugs

Krystyna Dobrowolska et al. World J Hepatol. .

Abstract

Background: Sex is one of the known factors influencing the risk of hepatitis C virus (HCV) infection and the natural course of the disease.

Aim: To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral (DAA) treatment in HCV-infected patients.

Methods: The study included consecutive 9457 women and 9529 men, treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project. Women were divided into pre-menopausal (15-44 years), menopausal (45-55 years) and post-menopausal (> 55 years) and compared with age-matched men.

Results: Regardless of age, women had a significantly lower body mass index, prevalence of genotype 3 infection and proportion of cirrhosis compared to men. Psychiatric disorders (except depression), hepatitis B virus and human immunodeficiency virus co-infections, as well as alcohol and drug addiction, were significantly less common in women than in men in all age groups. The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4% and 96.6%, respectively (P < 0.001). Independent predictors of treatment failure in women were genotype 3 infection, cirrhosis and postmenopausal age. Mild adverse events were reported significantly more often by women, regardless of age with the highest percentage in the postmenopausal group.

Conclusion: DAA treatment is more effective in women than in men, regardless of age, but in postmenopausal women, the effectiveness is relatively the lowest.

Keywords: Chronic hepatitis C; Direct-acting antivirals; Hepatitis C virus; Menopause; Women.

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Conflict of interest statement

Conflict-of-interest statement: Zarębska-Michaluk D has acted as a speaker and advisor for AbbVie and Gilead. Pawłowska M has acted as a speaker for AbbVie and Gilead. Berak H has acted as a speaker for Abbvie. Janczewska E has acted as a speaker and/or advisor for AbbVie, Gilead, MSD, and Ipsen, and has received funding for clinical trials from AbbVie, Allergan, BMS, Celgene, Cymabay, Dr Falk Pharma, Exelixis, GSK, and MSD. Mazur W has acted as a speaker and/or advisor for AbbVie, Gilead, and Merck, and has received funding for clinical trials from AbbVie, Gilead, and Janssen. Klapaczyński J has acted as a speaker for Gilead and AbbVie. Sitko M has acted as a speaker for AbbVie and Gilead. Piekarska A has acted as a speaker and/or advisor for AbbVie, Gilead, Merck, and Roche; Jaroszewicz J has acted as a speaker and/or advisor for AbbVie, Gilead, Merck, Roche, Alfasigma, MSD, Gilead, and PRO.MED. Flisiak R has acted as a speaker and/or advisor and has received funding for clinical research from AbbVie, Gilead, Merck, Roche, and Novo Nordisk. Dobrowolska K, Tudrujek-Zdunek M, Janocha-Litwin J, and Dybowska D have no conflict to declare.

Figures

Figure 1
Figure 1
Comparison of sustained virologic response between women and men in intent-to-treat and per protocol analysis in the whole group. A: Regardless of age; B: Age groups 15-44 years; C: 45-55 years; D: > 55 years. ITT: Intent-to-treat; PP: Protocol analysis.
Figure 2
Figure 2
Forest plot of odds ratio with confidence interval (odds ratio, 95% confidence interval, P value) from multiple logistic regression showing factors independently increasing the risk of virological failure 12 weeks post-treatment in females.
See this image and copyright information in PMC

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