Progression of hepatic fibrosis in irish females with HCV infection (genotype 1) – the impact of menopause

Introduction: Liver fibrosis is known to be highly variable within HCV infected cohorts. Co-factors for fibrosis progression include alcohol excess, steatosis and viral co-infection. Recent data suggest that low oestrogen and menopause are associated with accelerated fibrosis. This has not been validated in patients with paired biopsies.

Aims: To assess fibrosis progression rates (FPR) in females infected with HCV according to menopausal state.

Methods: HCV RNA positive females with at least two biopsies (n=66) formed the study cohort. Fibrosis stage was compared with menopausal state: pre-menopausal (pre-MP), peri-menopausal (peri-MP) and post-menopausal (post-MP). Information regarding diabetes, pregnancies, HRT, alcohol intake, smoking and hysterectomies was collected.

Results: Mean fibrosis scores comparing first and last biopsy was 1.11 and 1.71, mean interval between biopsies was 6.32 (range 1–14) years. Comparing first and last biopsies in pre-MP, peri-MP and post-MP groups there was no significant difference in FPR: 0.51 vs. 0.84, 0.19 vs. 0.47 and 0.19 vs. 0.69 (p=ns)

Conclusions: These data do not confirm the recently published observation that oestrogen is protective against fibrosis progression. The study numbers are limited but our study is the first to use paired biopsy series and known inoculation date. This study needs to be extended to other cohorts to validate the findings.