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IMPACT OF PREGNANCIES, ORAL CONTRACEPTION AND MENOPAUSE ON LIVER FIBROSIS PROGRESSION IN WOMEN WITH CHRONIC HEPATITIS C

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    NATAP - www.natap.org ... AASLD Dallas, Nov 9-13 see NATAP website for additional AASLD coverage Menopause, Hormone Contraception May Accelerate Liver
    Message 1 of 1 , Dec 3, 2001
      NATAP - www.natap.org
      ----------------------------------

      AASLD
      Dallas, Nov 9-13
      see NATAP website for additional AASLD coverage

      Menopause, Hormone Contraception May Accelerate Liver
      Fibrosis; Perhaps Hormone Replacement Therapy Can Be
      Helpful

      abstract 195. IMPACT OF PREGNANCIES, ORAL
      CONTRACEPTION AND MENOPAUSE ON LIVER FIBROSIS
      PROGRESSION IN WOMEN WITH CHRONIC HEPATITIS C

      Vincent Di Martino, Pascal Lebray, Joseph Moussalli,
      GH Piti�-Salp�tri�re and R�seau VHC Paris-Sud, Paris
      France; Catherine Buffet, HTMpital Bic�tre et R�seau
      VHC-Paris Sud, Kremlin-Bic�tre France; Thierry
      Poynard, GH Piti�-Salp�tri�re and R�seau VHC
      Paris-Sud, Paris France

      program abstract:During chronic hepatitis C (CHC),
      liver fibrosis progression is faster in males than in
      females. Among all the factors involved in such
      difference, estrogenes may be a major one since
      experimental data recently supported that estrogenes
      may have direct antifibrosing effect. The aim of this
      work was to evaluate the influence of pregnancies,
      oral contraceptives and menopause on liver fibrosis
      (F) and fibrosis progression rate (FPR) in
      HCV-infected women, taking into account confusing
      factors such as age, alcohol consumption, and BMI.

      Patients and methods: 472 women with CHC without HBV
      nor HIV coinfection received an anonymous
      questionnaire that asked for alcohol and tobacco
      consumption, presence of diabetes, age at first
      menstruation, age at pregnancies with or without
      children, hormonal contraception, age at menopause and
      its cause if any, and hormonal substitution. These
      data were completed by those collected in the DOSVIRC
      database. Liver biopsies performed before antiviral
      therapy were analyzed using the METAVIR scoring
      system. The FPR was estimated in case of known date of
      HCV infection and expressed in milli METAVIR Units of
      fibrosis per year. Statistical analyses were performed
      using Kruskall-Wallis rank test and logistic and
      multiple linear regression models for multivariate
      analyses.

      Results: 212 (44%) women completed the questionnaire.
      192 (48�1 years old) underwent adequate liver sample,
      among whom 99 had 1 to 7 pregnancies (0 to 5 children)
      during 15�1 months, 86 received oral contraceptive(s)
      during 31�4 months, 95 had menopause 11�1 years before
      liver biopsy, and 47 received hormonal substitution
      during 7�1 years. Only one woman had alcohol intake
      more than 50g/d. In univariate analysis, F score
      and/or FPR were significantly lower in women who had
      one or more pregnancies, who received hormonal
      contraception, who were seen before menopause or who
      received hormonal substitution, whereas liver
      necro-inflammatory lesions(A) were not different
      (table). After adjustment on age and BMI, multivariate
      analyses showed that menopause was associated with
      higher F score and FPR, and that pregnancies were
      associated with lower FPR ; the effect of oral
      contraceptives was not significant.

      Conclusion: in women with CHC, menopause accelerates
      the liver fibrosis progression. Such effect seems
      prevented by hormonal substitution. Pregnancies may
      have a long-term beneficialimpact on liver fibrosis.

      editorial note: a pilot study presented at the AASLD
      Single Conference meeting in June 2001 showed HRT
      could improve response to HCV therapy for
      postmenopausal women


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