Sex difference in chronic hepatitis b virus infection: Studies of serum hbeag and alanine aminotransferase levels in 10, 431 asymptomatic chinese hbsag carriers

To study the difference between the sexes with regard to chronic hepatitis B virus infection, we surveyed levels of serum hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT) among 10, 431 asymptomatic Chinese carriers of hepatitis B surface antigen (HBsAg) in Taiwan. There were 7, 095 men and 3, 336 women in this study; ages ranged from 15 to 70 years. HBeAg was detected in 19.6% of HBsAg carriers. The prevalence of HBeAg decreased significantly with increasing age. HBeAg was detected in 17.7% of men and 23.6% of women. After correction for the confounding effect of age, it was found that the prevalence of HBeAg was significantly higher among women than among men. The level of serum ALT was abnormal in 20.8% of HBsAg carriers. Abnormal ALT levels were significantly more frequent among HBsAg carriers who tested positive for HBeAg (39.7%) than among those who did not (16.2%; P <.001). Among the HBeAg-positive carriers, 43.2% of men and 34.2% of women had abnormal ALT levels, and men were 1.45 times more likely to have abnormal ALT levels than women (P <.001). Among the carriers who were negative for HBeAg, 20.6% of men and only 6.0% of women had abnormal ALT levels, and men were 3.98 times more likely to have abnormal ALT levels than women (P <.001). Overall, 24.6% of men and only 12.6% of women had abnormal ALT levels, and men were 2.33 times more likely to have abnormal ALT levels than were women (P <.001). The male-to-female ratio was 2.1:1 among whole asymptomatic HBsAg carriers, and it increased to 4.1:1 in asymptomatic HBsAg carriers with abnormal levels of ALT and to 7.9:1 among those negative for HBeAg with abnormal ALT levels. These figures were in keeping with those reported previously for men and women with chronic hepatitis B in Taiwan and suggest that the relative risk for the development of chronic hepatitis B increases progressively during the course of chronic hepatitis B virus infection in men when compared with that for women.