Report 2
     Reported by Jules Levin

Estrogen Replacement Therapy Enhances The Response Rate to Interferon Of HCV+ Post Menopausal Women

It has been observed that women respond better to interferon for chronic HCV than men. And that younger women do better than older women. Estrogens are known to contribute to the regulation of the immune response and the liver is an estrogen-responsive organ. The purpose of this study was to determine whether the response rate to IFN differs between pre- and post-menopausal women on estrogen replacement therapy. Alessandra Colantoni (Loyola University Chicago) studied 26 pre- and 30 post-menopausal women (18 untreated post-menopausal and 12 post-menopausal women on estrogen replacement therapy) with chronic hepatitis C. It’s my understanding that in HCV/HIV coinfection a problem posed is that drug interactions of estrogen and HIV medications are not well understood.

47 men, age and Knodell score matched with each of the women studied, were treated with 5 MU/day IFN for 6 months and served as controls. The response was defined as HCV RNA negativity in serum and a normalization of liver enzymes. The response rate to IFN therapy was evaluated at the end of treatment and 6 months after treatment was suspended.

RESULTS
The end of treatment response was

• 80% in the pre-menopausal women, while it was
• 38% in the post menopausal women not on hormone replacement therapy.

On the other hand, a response rate to IFN of 50% was found in HCV+ post-menopausal women on estrogen replacement therapy.

Among the men, 65% responded to the IFN. The sustained response observed 6 months after discontinued therapy was 30% in women and 39% in men. A sustained response was achieved in 28% of the pre-menopausal women, in 12% of the post-menopausal not on hormone replacement therapy, and 30% of the post-menopausal women on estrogen replacement therapy.

As age is one of the predictors of a response to IFN, the end of treatment response for the women and men was analyzed after the two groups were matched for age. The age range for the pre-menopausal women was 32-52, and 44-72 for the post-menopausal women. Among the younger patients, the response rate to IFN was significantly higher in women (75% vs 62%). No difference in IFN response rate was seen between older men and older women not on HRT.

The authors concluded that the response rate to IFN for chronic hepatitis C is influenced by estrogen status. And estrogen replacement therapy enhances the response rate to IFN therapy.