Menopause May Accelerate Liver Fibrosis; Perhaps Hormone Replacement
Therapy Can Be Helpful
abstract 195. IMPACT OF PREGNANCIES, ORAL CONTRACEPTION AND MENOPAUSE
ON LIVER FIBROSIS PROGRESSION IN WOMEN WITH CHRONIC HEPATITIS C
Vincent Di Martino, Pascal Lebray, Joseph Moussalli, GH Pitie-Salpetriere
and Reseau VHC Paris-Sud, Paris France; Catherine Buffet, HTMpital Bicetre
et Reseau VHC-Paris Sud, Kremlin-Bictre France; Thierry Poynard,
GH Pitie-Salpetriere and Reseau VHC Paris-Sud, Paris France
During chronic hepatitis C (CHC), liver fibrosis progression is faster
in males than in females. Among all the factors involved in such difference,
estrogenes may be a major one since experimental data recently supported
that estrogenes may have direct antifibrosing effect. The aim of this
work was to evaluate the influence of pregnancies, oral contraceptives
and menopause on liver fibrosis (F) and fibrosis progression rate (FPR)
in HCV-infected women, taking into account confusing factors such as age,
alcohol consumption, and BMI.
Patients and methods: 472 women with CHC without HBV nor HIV coinfection
received an anonymous questionnaire that asked for alcohol and tobacco
consumption, presence of diabetes, age at first menstruation, age at pregnancies
with or without children, hormonal contraception, age at menopause and
its cause if any, and hormonal substitution. These data were completed
by those collected in the DOSVIRC database. Liver biopsies performed before
antiviral therapy were analyzed using the METAVIR scoring system. The
FPR was estimated in case of known date of HCV infection and expressed
in milli METAVIR Units of fibrosis per year. Statistical analyses were
performed using Kruskall-Wallis rank test and logistic and multiple linear
regression models for multivariate analyses.
Results: 212 (44%) women completed the questionnaire. 192 (48±1
years old) underwent adequate liver sample, among whom 99 had 1 to 7 pregnancies
(0 to 5 children) during 15±1 months, 86 received oral contraceptive(s)
during 31±4 months, 95 had menopause 11±1 years before liver
biopsy, and 47 received hormonal substitution during 7±1 years.
Only one woman had alcohol intake more than 50g/d. In univariate analysis,
F score and/or FPR were significantly lower in women who had one or more
pregnancies, who received hormonal contraception, who were seen before
menopause or who received hormonal substitution, whereas liver necro-inflammatory
lesions(A) were not different (table). After adjustment on age and BMI,
multivariate analyses showed that menopause was associated with higher
F score and FPR, and that pregnancies were associated with lower FPR ;
the effect of oral contraceptives was not significant.
Conclusion: in women with CHC, menopause accelerates the liver
fibrosis progression. Such effect seems prevented by hormonal substitution.
Pregnancies may have a long-term beneficial impact on liver fibrosis.
editorial note: a pilot study presented at the AASLD Single Conference
meeting in June 2001 showed HRT could improve response to HCV therapy
for postmenopausal women.