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and ultrasonographical parameters, and presence between virological responses and gender considering
of fibrosis at baseline: beyond age and gender, the the whole sample: RVR, cEVR, ETVR and SVR
factors appeared associated to SVR were RVR, GGT frequencies were higher in woman and the relapse
levels and 0-2 fibrosis. RVR was a powerful predictive rate was higher in men even though no statistically
factor of SVR in previous studies, showing as patients significant difference resulted, so indicating as the
with RVR had ratio of SVR meaningfully higher than gender influences not the therapy outcome.
others; moreover some studies suggest RVR as the
most important SVR predictor. [17-20] Nevertheless meaningful gender differences
emerged after stratification by age (< and > 50
Villela-Nogueira et al. identified that higher levels years). We noticed < 50 years aged women had a
[21]
of GT during a pre-treatment may be a independent higher frequency of response and a lower relapse
negative predictive factor of response to treatment: rate compared to men belonging to the same age
being a biochemical parameter easily available and group, differences appearing statistically meaningful
at low cost, it may be incorporated in evaluation due to the absence of RVR, cEVR, ETVR, and SVR,
of response to treatment alongside with other suggesting as female gender would be a positive
predictive factors. predictive factor of response to the therapy.

In conclusion several studies demonstrated that Otherwise, in the > 50 years aged group frequency
higher degrees of fibrosis have been associated of RVR and ETVR appeared higher in men whilst SVR
with lower rates of response. To evaluate the was slightly higher in women: men had higher relapse
effectiveness of treatment, several indicators of ratio compared to women and so reaching less
response were analysed, in particular SVR which frequently SVR. The evidence of a better response
represents the optimal outcome of treatment. There to therapy in < 50 year-old females than in co-aged
is no concordance of opinion concerning the gender men and of an alike response in the > 50 years in
role on the response to the treatment. both groups leads to formulate several hypotheses.
It may be supposed only a worsening in women
In literature there are few studies which identify older than 50 years compared to those younger ones
alike responses in two genders after making linked to an alike response among men before and
comparisons between men and women in patients after 50 years, or we may assume a deterioration
younger than 40-50 years. Two recent works do not with age in both genders even though it is more
detect a significant influence of genre even though accentuated in women. Another theory considered
both identified a meaningfully greater response in the possibility of a rapprochement between sexes
women younger than 40-50 years compared to the with age linked to a worsening in female gender and
eldest ones Other studies consider the male gender an improvement in > 50 year-old males. Finally, it
as one of the strongest factors to predict SVR. [17,25] could exist an improvement in men with age up to
Furthermore data concerning rates of SVR in women the level of women younger than 50 years without
are conflicting; studies which identified female a real worsening of women older than 50 years; this
gender as an independent factor linked to SVR or condition may be true whether there is a meaningful
which noticed as not exist meaningful differences in improvement in men older than 50 years and an alike
genders were not stratified by age and considered not response in > 50 year-old women compared with
differences in female hormonal status; [20,22,23] other younger and same gender patients.
studies suggested a better response in women even
after splitting the sample into age groups. [13,19,23,24] Comparing the response frequencies in younger and
older than 50 year-old males, we could exclude the
Few studies lead to identify alike responses in < 40- last two hypothesis, having observed a less response
50 year-old patients of both genders: recent works in > 50 year-old patients in both genders without
detected not a significant influence of gender even an improvement in these men compared to the < 50
though in presence of a better response in < 40-50 year-old ones.
year-old women compared to the elder ones; other
studies considered the male gender as a strong Since women responded to the treatment differently
factors to predict SVR. by age and they achieved the viral clearance more
frequently than men, the hormonal activity and
Our outcomes did not identify meaningful association especially oestrogen levels may be associated to

128 Hepatoma Research | Volume 2 | May 6, 2016