Impact of menopause on the clinical management of chronic hepatitis c in women

The liver, although not a classical target for estrogens, is sensitive to their effects, particularly in cases of deprivation. Menopause is a key event in the life of a woman: apart from the hormonal changes, it determines a shift from a low-inflammatory to a proinflammatory state. This has a series of well-known consequences on many different organs and tissues, including bone, heart, brain, adipose tissue, and, among others, liver. The consequences are extremely evident in hepatitis C virus (HCV)-positive women: in these, HCV infection and menopause cooperate to induce higher necroinflammatory activity, increased hepatic steatosis, and eventually faster progression of fibrosis. Furthermore, menopause is the strongest negative factor for sustained viral response (SVR) in HCV-positive females, especially HCV genotype 1 patients (in whom this is the only independent factor for failure of antiviral therapy). This suggests that HCV-positive women should be treated early during fertile age to obtain maximal response to antiviral therapy. © 2010 FBCommunication s.r.l. a socio unico.