New research shows men in Egypt, a country with the highest prevalence of hepatitis C virus (HCV) in the world, are at a higher risk of HCV than females.¹

A team, led by Muhammad Abdel-Gawad, Hepatology, Gastroenterology, and Infectious Diseases Department, Assiut Faculty of Medicine, Al-Azhar University, reviewed and evaluated the gender differences in HCV infection rates in Egypt.

The Problem in Egypt

Egypt currently has the highest rate of HCV among its population worldwide. However, the origin of gender differences in HCV prevalence is generally not well understood and more data would support better prevention and control programs to minimize HCV-related morbidity and mortality.

“Research has shown a growing interest in health-related gender differences and raises the question of gender-biased differential response that is relevant in many health fields, including the prevalence, risk factors, clinical features, and treatment of diseases,” the authors wrote. “Still, the epidemiological pattern of HCV infection in research and medical practice requires further knowledge of the potential role of gender differences.”

Some studies have supported the idea that HCV infection is prevalence and progresses more rapidly in males, while other studies have found gender differences to be artifactual. In addition, some studies have shown a decreased rate of liver cirrhosis and hepatocellular carcinoma (HCC) in females, with more progression to hepatic fibrosis in males and more liability to adverse events of direct-acting antivirals (DAAs) in females.

Some explanations for these discrepancies are that women are generally more exposed to syringes, blood, and blood products, particularly during pregnancy and labor and ear piercing. This puts them at a higher risk of HCV infection.

In Egypt, some data shows that anti-HCV prevalence in the general population was higher in males than in females (19.67% vs. 9.73%; P <0.001), (16.1% vs. 13.4%; P <0.001), and (7.5% vs. 5.3%; p <0.001), while other studies found more anti-HCV prevalence in women than in men in special situations: (13.4% vs. 7.3%; P = 0.045) among family contacts of HCV-positive children, (25.2% vs. 17.6%; P = 0.031) in patients with coronary heart disease, and (25.1% vs. 15%; P = 0.002) in apparently healthy blood donors.

The Data

In the study, the investigators searched several databases for relevant studies between 2011-2021. Overall, they identified 616 studies involving 97,597 male patients and 96,024 female patients.

The results show the overall seroprevalence of HCV antibodies in all studies was 0.02 (95% confidence interval [CI], -0.23 to 0.28). There were no significant difference between males and females.

On the other hand, HCV RNA positivity was significantly more prevalent in the male patient than it was for females in both adults and the general population after excluding high-risk groups.

In the pediatric population, there was no statistically significant differences in the seroprevalence of HCV antibodies or in the prevalence of PCR positivity between the 2 genders.

“HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children,” the authors wrote.

References:

Abdel-Gawad, M., Nour, M., El-Raey, F. et al. Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis. Sci Rep 13, 2499 (2023). https://doi.org/10.1038/s41598-023-29262-z