Hepatitis B Infection Risk May Be Higher for Males

Males are more likely to suffer from the sexual dimorphism of hepatitis B infection, suggesting that sex hormones have a role in complication risk.

Hepatitis B virus (HBV) can influence sex hormone response elements, according to the authors of a study published in the National Library of Medicine. Additionally, the authors explained that these sex hormone response elements may share responsibility for increasing the risk of acute liver failure in patients with HBV. Futher, females with HBV were observed to be less likely to contract liver disease and chronic infection then males.

“Enhancing an understanding of the mechanisms through which sex hormones mediate their influence can inform a better understanding of the pathophysiology of liver disease, with potentially important bearing on the use of existing interventions as well as informing the development of new therapies for HBV,” study authors wrote in the report.

HBV is the biggest contributor of liver cancer worldwide. Almost 300 million people are infected with HBV each year and annually, over 1 million people die from it. It is considered a global health problem.

The study authors observed that sexual dimorphism, which is described as the different infection outcomes and susceptibilities between males and females in infectious diseases such as HBV, was a key component to reaching a better understanding of chronic HBV. Since understanding chronic HBV (CHB) has the potential to lead to better evidence-based treatments and prevent subsequent liver disease, researchers collected human and animal data to understand the mechanism, outcomes, and impact of sexual dimorphism on HBV to better inform HBV treatment, surveillance, and prevention.

The study results showed that social behaviors and viral function have a complex interplay in the disease; the investigators determined that having a better understanding of this relationship could help to create treatments and interventions to combat sexual dimorphism from HBV and CHB in males and females.

Since males were found to be more likely to develop CHB than females, the authors explained that expanding CHB treatment may be a key intervention toward progress in elimination goals by offering therapy to those at greatest risk of long-term disease as well as switching off transmission.

Other sexual dimorphisms that males were more likely to contract include complications like cirrhosis and hepatocellular carcinoma. Further, outcomes were found to depend on multiple factors, including immune responses, the impact of sex and age, hormonal changes at puberty—and particularly among females, hormonal changes at later stages in life, such as pregnancy and menopause. Finally, the role of gender was found to have a complex role in access to health care, treatment, and even diagnosis.

Childhood vaccination against HBV is far and wide the most effective method of reducing early-life infections than can account for lifetime CHB. Researchers are seeking to fill the knowledge gaps that remain about decreasing sexual dimorphism in HBV, education, screening, and women’s health in general.

“Improving the reporting of sex and gender data is imperative for HBV, as deepening an understanding of the biology and pathophysiology can inform new interventions, while stratification for treatment or surveillance by sex has the potential to improve outcomes for individuals, with associated population benefits in areas of high endemicity,” study authors wrote.


Brown R, Goulder P, Matthews P. Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts. Natl Lib of Med. 2022;7:32. doi:10.12688/wellcomeopenres.17601.3