Sex Differences in Cirrhosis Incidence Among Untreated Chronic Hepatitis B Patients: A 10-year Chinese Cohort Study

Current guidelines for antiviral treatment of chronic hepatitis B are based on age, alanine aminotransferase levels, viral load, a family history of hepatitis B virus-related cirrhosis, or hepatocellular carcinoma, while not considering sex as a factor.

This retrospective longitudinal cohort study included 1543 untreated patients with chronic hepatitis B (760 male and 774 female) not meeting antiviral treatment criteria in previous guidelines and investigated sex differences in liver disease progression according to the latest Chinese guidelines for the prevention and treatment of chronic hepatitis B (2022).

The cumulative incidence of cirrhosis was significantly higher in male patients compared with female patients among all untreated patients with chronic hepatitis B (23.1% vs 7.9%; P < .001), treatment-eligible patients (25.3% vs 8.0%; P = .001), and treatment-ineligible patients (20.6% vs 7.3%; P < .001). Male sex was strongest risk factor for cirrhosis (hazard ratio, 2.474; 95% confidence interval, 1.628-3.760; P < .001) among untreated patients with chronic hepatitis B. Male patients showed a relatively high incidence of cirrhosis, although not meeting antiviral treatment criteria, whereas female patients showed a relatively low incidence of cirrhosis, although meeting antiviral treatment criteria. In treatment-eligible female patients, those with abnormal alanine aminotransaminase (10.4%) showed a numerically higher incidence of cirrhosis compared with those with normal alanine aminotransaminase. In treatment-ineligible patients, male sex was a risk factor for cirrhosis.

In conclusion, male patients showed a higher risk of cirrhosis than female patients in untreated patients with chronic hepatitis B. Expanding antiviral treatment criteria may be considered in male patients, but not in female patients. Initiating antiviral treatment may be stratified by sex.