TY  - JOUR
AV  - public
N2  - Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV). HBV is a substantial global health problem, with close to 300 million people chronically infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, and consider how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.
KW  - hepatitis
KW  -  HBV
KW  -  sex
KW  -  gender
KW  -  oestrogen
KW  -  testosterone
KW  -  androgen
KW  -  cancer
KW  -  hepatocellular carcinoma
KW  -  gender
KW  -  stigma
KW  -  epidemiology
KW  -  outcome
KW  -  treatment
KW  -  dimorphism
A1  - Brown, Robin
A1  - Goulder, Philip
A1  - Matthews, Philippa C
PB  - F1000 Research Ltd
VL  - 7
JF  - Wellcome Open Research
N1  - Copyright © 2022 Brown R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
TI  - Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts [version 3; peer review: 2 approved]
Y1  - 2022/05/11/
UR  - https://doi.org/10.12688/wellcomeopenres.17601.3
ID  - discovery10148644
ER  -