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7 Ways Hepatitis C Affects Women Differently than Men

Nicole Cutler L.Ac. June 5, 2014

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Although the virus itself does not discriminate against gender, these seven differences between men and women with Hepatitis C are worth reviewing.
7 Ways Hepatitis C Affects Women Differently than Men

First discovered as a contagious virus in 1989, Hepatitis C currently infects an estimated four million Americans. While this highly transmissible virus does not discriminate against sexuality, age or race, there are some factors contributing to Hepatitis C’s slightly different impact on men and women.

More people die annually with Hepatitis C than HIV, the virus that causes AIDS; but Hepatitis C education pales in comparison. Increased public health efforts have steadily improved Hepatitis C awareness, but most experts agree we still have a far way to go.

Learning about some of the different issues attributed to Hepatitis C and gender does not change the fact that Hepatitis C is a highly contagious, blood-borne virus. If infected blood makes contact with the blood of someone who is not infected, both men and women are susceptible to chronic Hepatitis C infection – regardless of their gender. However, variations between how the virus impacts the sexes could lend some insight to future treatment, prevention and research efforts.

Seven ways Hepatitis C affects women and men differently are described below:

  1. Developing Cirrhosis – According to the U.S. Centers for Disease Control and Prevention, scarring of the liver (cirrhosis) occurs in 5 to 20 percent of people with chronic Hepatitis C. However, women seem to be more protected against liver cirrhosis than men. According to a 20 year multi-center German study published in the journal Hepatology in July 2000, only .004 percent of the 1,018 women studied developed cirrhosis. Experts believe that the female hormone estrogen protects women from liver damage – making them less susceptible to cirrhosis. If this is the case, the protective effect may diminish after menopause, when women’s bodies produce less estrogen.
  2. Intravenous Drug Use with a Sexual Partner – Although there are many ways of being exposed to a blood-borne virus, sharing intravenous drug needles is the easiest way to transmit Hepatitis C. According to a study published nearly ten years ago in the journal Emerging Infectious Diseases, researchers found that women are more likely to share needles or start using intravenous drugs with a sexual partner than men are.
  3. Spontaneous Clearance – Of those infected, about 85 percent will develop chronic Hepatitis C infection. The other 15 percent are lucky; their bodies are able to get rid of the virus without medication. This phenomenon is known as spontaneous clearance. However, spontaneous clearance seems weighted toward women. Based on a 2014 study published in the journal Hepatology, women are more likely than men to have spontaneous clearance. Researchers do not know why the Hepatitis C clearance rate is higher in women than men but suspect that estrogen’s liver protective property may be partly responsible.
  4. Menstruation Transmission – Sexual transmission of Hepatitis C is uncommon, with most studies showing that 0 to 3 percent of people in a steady, monogamous relationship with a Hepatitis C-positive partner become infected through unprotected heterosexual intercourse. Similar to HIV, Hepatitis C may be more efficiently transmitted through anal sex than through vaginal intercourse because of the greater risk of blood exposure. However, Hepatitis C is more likely to be sexually transmitted when a woman is having her menstrual period (from the menstruating woman to her partner) due to the presence of blood.
  5. Cesareans Over 22 Years Ago – Because it can be asymptomatic for 20 to 30 years or more, many people remain unaware that they have Hepatitis C. Before 1992 when testing for Hepatitis C began, this virus was often contracted via blood transfusions. In the 1970s and 1980s, before Hepatitis C was identified, women often received blood transfusions when they underwent Cesarean delivery (C-section) – and some were unaware that they received donated blood. Thus, experts suggest that women who had a C-section before 1992 be tested for Hepatitis C.
  6. Ribavirin and Anemia – Although many new Hepatitis C drugs are in the development pipeline, all medications create side effects. One medication frequently used in combination with others to treat Hepatitis C is ribavirin. Anemia (low red blood cell count) is a serious and common side effect of ribavirin. Because women lose blood each month through menstruation, they are more likely than men to develop anemia; thus, menstruating women on ribavirin should have their blood cell levels monitored regularly.
  7. Hormone Pills – Oral contraception pills are the most popular contraceptive method in the U.S. and are generally safe for women with Hepatitis C. Likewise, hormone replacement therapy (HRT) is one of the most common routes for supporting menopausal women and it is generally safe for women with Hepatitis C. Unfortunately, estrogen-containing pills (oral contraception and HRT) are not advisable for women with severe liver disease. Because a significantly damaged liver may not be able to break down these hormones, those with severe liver disease should consult their doctor (and maybe even get a second opinion) if considering oral contraception or HRT.

With an estimated four million Americans living with chronic Hepatitis C, improved public education efforts are in demand. Although blood-to-blood contact poses a Hepatitis C infection risk to anyone, the seven circumstances listed above demonstrate slight differences in how the Hepatitis C virus impacts woman and men.

http://health.usnews.com/health-news/news/articles/2012/02/20/hepatitis-c-now-kills-more-americans-than-hiv, Hepatitis C Now Kills More Americans than HIV, Steven Reinberg, Retrieved June 1, 2014, US News & World Report, 2014.

http://onlinelibrary.wiley.com/doi/10.1002/hep.26639/abstract;jsessionid=12E1A42F80035F0CFC1A3DF853CF9FDD.f04t02, The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection, Jason Grebely, et al, Retrieved May 30, 2014, Hepatology, January 2014.

http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm, Hepatitis C FAQs for Health Professionals, Retrieved June 1, 2014, US Centers for Disease Control and Prevention, 2014.

http://www.guttmacher.org/pubs/fb_contr_use.html, Contraceptive Use in the United States, Retrieved June 1, 2014, Guttmacher Institute, 2014.

http://www.hcvadvocate.org/hepatitis/hepc/wmnlong.html, Women and HCV, Liz Highleyman, Retrieved May 26, 2014, Hepatitis C Support Project, 2014.

http://www.healthline.com/health-slideshow/hepatitis-c-symptoms-women, What Are the Symptoms of Hepatitis C in Women?, Diana Bocco, Retrieved May 29, 2014, Healthline Networks, Inc., 2014.

http://www.hepatitisaustralia.com/women-and-hep-c/, Women and Hepatitis C, Retrieved May 30, 2014, Hepatitis Australia, Inc., 2014.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329031/, Prevention of Hepatitis C in Women, Beth P. Bell, et al, Retrieved June 1, 2014, Emerging Infectious Diseases, November 2004.

http://www.ncbi.nlm.nih.gov/pubmed/10869294, Low Frequency of Cirrhosis in a Hepatitis C (genotype 1b) single-source outbreak in Germany – a 20-year multicenter study, Wiese M, et al, Retrieved June 1, 2014, Hepatology, July 2000.

http://www.ncbi.nlm.nih.gov/pubmed/23908124, The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection, Grebely J, et al, Retrieved June 1, 2014, Hepatology, January 2014.

http://www.sciencedaily.com/releases/2013/09/130912112812.htm, Women Have Higher Rates of Spontaneous Clearance of Hepatitis C Virus, Retrieved May 30, 2014, ScienceDaily, LLC, 2014.

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  • paul

    Nice sensitive article for women, however, needs to highlight that c sections are just 1 of many healthcare transmission routes a lady needs to test. Any blood or product or surgery in the West before 1992 needs a safety test. Sexually speaking it is important for women to understand that HCV is simply not a sex disease as it is not infectiously present in sexual fluids. 15,000 life years of sexual activity has reported zero risk or infection
    in the EU wide study. Sharing the razor, forgetting the plasters would be the infectious risk. Condoms are quite pointless infection wise here and tend to distract from the real risks of forgotten plasters and blood hygiene. Perhaps most important is to point out HCV is not highly infectious at all, as the thousands of partners in the EU study know full well. Medicare is 95% responsible and fortunately we as a world have progressed enormously.
    Paul Desmond

    • Marianne

      Absolutly agree-lousy nurses and doctors, all medical staff in hospitals and labs are posing risk to public health more then they do cure.

      • Annita

        Marianne: perhaps you forget that doctors, nurses and lab techs are directly exposed to infectious disease of the patient and are very high risk for contracting disease from patient, not the other way around. I resent the label of “lousy nurse”-/ I was exposed to blood splatters of patients directly to my eyes and mouth by patients. I developed HepC via blood transfusions. I continued to function as a nurse ALWAYS aware of covering any cuts, wearing gloves to protect patients and myself, and teaching others to practice safety with needles– someone’s carelessness did cause me to receive a needle stick from a used iv catheter — and I was furious! Carelessness should not happen in any healthcare field. Firefighters and paramedics are also at risk. All these providers save lives— and sometimes are human making careless mistakes. Generalizing a label of “lousy doctors and nurses ” as responsible for HCV transmission leaves no room for our own ignorant choices of behavior when we out ourselves into dangerous situations. In my case– it was a less than perfect doctor that contributed to complications of childbirth resulting in transfusions of blood and cryoprecipitate most likely responsible for HCV, almost 30 years ago now. Waiting for pre-authorization for treatment and hoping. Symptoms ending my nursing career 10 years ago. Doctors respected my skill and insight into patient status and needs. Patients and families appreciated my care and knowledge. Co-workers sought me out for consultation and opinion on patient status. I was NOT a “lousy nurse”. No one came in contact with MY blood.

  • juliet

    I don’t agree that women are less likely to get cirrhosis hep c 1b went through me like a freight train; recovered from hep c dated a heroin addict.

  • jae s

    Thinking seriously about taking solovadi and the new drug they tried in japan from gilead pham. around xmas . Wish me the best. Living with h/c for a very long time 42yrs.

    • dbzc

      I just finished 12 weeks of sovaldi & olyssio and am waiting for my blood work results to see if I am still in remission. I found that while these two drugs do not cause the same kinds of side effects as interferon or ribavarin, I did experience quite a bit of pain, headaches, insomnia and was in a brain fog the entire time. Re., the article, what they left off, men are more likely to resolve and stay in remission after interferon treatment than women. And the biggie the one thing that does not play into gender 1A is one of the hardest genotypes of Hep C to get a sustained response except with the newer drugs.., the ones I just finished and you are about to go on! Good luck!

    • tina

      My partner of many, many years just saw a podcast/webinar featuring Dr. Ahmed and had not registered yet but when she saw this, asked me if she could use my laptop to respond to your comment. How could I say no! so here is her entry:
      hey jae s…in response to your comment made 20 days ago (according to this sites records) I am brand new to this web site and read your comment where you needed some ‘best wishes’ as you begin your journey using solovadi. Personally, I have have NOT started yet, but my Dr is getting me reved up for the latest cocktail which includes solovadi.
      HERE ARE 10 thousand BEST WISHES lovingly sent your way.
      I wasn’t clear if you were 42 yrs of age or you’ve been living with Hep C for 42 yrs…if you’ve had HepC for that long, I am in awe of your enduring strength. I am, on the other hand, 64 yrs old and was initially diagnosed in 08. I have 3 diff types of artiritis & was seeing a new RA physician who’s office was a good hour away.I had all the blood work done after my initial appt w/him and was sitting in the exam room for my return appt to review results, etc. Anywho….. he was highly regarded and very knowledgeable about many things.I was so excited He was telling me that they had a new way of slowing down RA, OA and Anklyosing Spondilitis and said something like “this new treatment would really make a positive difference but some adjustments would have to be made because of the Hep C.’. Excuse me? What did you just say. He repeated it & then asked me if I even knew I had Hep C. Of course, I had not. This girl has had plenty of blood work done especially my earlier years because of health problems in my youth which included a transfusion and NOBODY ever told me there were any odd results that would indicate or alert them to the fact that I had any issues with my Liver. He said many things after that which, of course, was never heard by this brain. I was shocked, filled with an anger I can’t even find words for and felt that I had just been given my death notice. I felt so scared of something I knew nothing about.That poor Dr, I never did go back to see him..(.I should probably apologize to him) …. after a minute of him talking about a promising treatment for my arthritis’ he stopped – probably noticed I had left the building..if you know what I mean. My body was right there in front of him, it became clear my mind was somewhere else.He asked me if I was ‘OK” my response was uh-hu or something like that. So he started back up about how we’re gonna attack that arthritis of mine and stopped again. It took everything I had not to go into full out bawling. He suggested we continue the conversation at our next appt and asked If I was ok to drive…and if not, I could stay in his office until I had a chance to gather myself, then drive. I said I would be ok & would prefer sitting in my car where I had more privacy. Enough of too many details. I went home and dove into the internet to read up on this Hep C thing. The more I read, the more unsure I was about getting treatment…which one. so approx 9 mos later I started up on what would be my first of 3 different ‘trial treatments’ using interfuron (sp) chemo therapy over a period of approx 4 years. I did clear for 3 weeks but the virus had come back. I am due to face another treatment in the 2 months. Unfortunately, once the virus was back my body just couldn’t more like refused to tolerate the interfuron.. I almost did not survive this last time because of complications of side effects & now have to take Thyroid Rx for the rest of my ‘long sweet life. I basically have no immune system left, have absolutely no appetite ever :(, my vision was significantly impacted and I enjoyed Encepha la la la(serious brain fog) (sp). There are a few more issues to deal with but I have always felt like I could not allow myself to sit around waiting to die, after all that I’ve been thction & crossing over that LINE of being untreatable.. the point of no return chance. Anyway, I am not far behind you in your treatment knowing the word ‘cure’ is being used….very carefully but a cure is near. One thing I kept hearing from Dr Ahmed ‘when you clear the HPV, do not forget to continue treating your existing issues ie Cirrhosis, Fibrosis. Again, many best wishes to you. We have all gone through so much..there’s so much to say. it gives me a new appreciation of the human spirit! But enough about me, what do you think about me? That was a joke. I do wish you the best on this wild ride. Remember to laugh at every opportunity… humor has a huge impact on our ability to fight this