eprintid: 10148644 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/14/86/44 datestamp: 2022-05-17 10:59:19 lastmod: 2022-05-17 10:59:19 status_changed: 2022-05-17 10:59:19 type: article metadata_visibility: show sword_depositor: 699 creators_name: Brown, Robin creators_name: Goulder, Philip creators_name: Matthews, Philippa C title: Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts [version 3; peer review: 2 approved] ispublished: pub divisions: C10 divisions: D15 divisions: B02 divisions: UCL keywords: hepatitis, HBV, sex, gender, oestrogen, testosterone, androgen, cancer, hepatocellular carcinoma, gender, stigma, epidemiology, outcome, treatment, dimorphism note: 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. abstract: 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. date: 2022-05-11 date_type: published publisher: F1000 Research Ltd official_url: https://doi.org/10.12688/wellcomeopenres.17601.3 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1956038 doi: 10.12688/wellcomeopenres.17601.3 lyricists_name: Matthews, Philippa lyricists_id: PMATT18 actors_name: Kalinowski, Damian actors_id: DKALI47 actors_role: owner full_text_status: public publication: Wellcome Open Research volume: 7 article_number: 32 citation: Brown, Robin; Goulder, Philip; Matthews, Philippa C; (2022) Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts [version 3; peer review: 2 approved]. Wellcome Open Research , 7 , Article 32. 10.12688/wellcomeopenres.17601.3 <https://doi.org/10.12688/wellcomeopenres.17601.3>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10148644/1/Matthews_Sexual%20Dimorphism%20in%20Chronic%20Hepatitis%20B%20Virus%20%28HBV%29%20Infection_VoR.pdf