Impact of gender, viral transmission and aging in the prevalence of hepatitis B surface antigen.

BACKGROUND Age, gender, and perinatal infection are associated with hepatocarcinogenesis. The influence of perinatal transmission in chronic hepatitis B virus infection between genders at different ages is not well documented. METHODS A consecutive series of individuals who had general check-ups and three groups of relatives of patients with hepatocellular carcinoma were analyzed. Siblings of index cases and children of female index cases represented groups with high perinatal transmission, while children of male index cases represented a low perinatal transmission group. RESULTS A total of 45,035 individuals who had general check-ups and 14,513 first degree relatives of patients with hepatocellular carcinoma were included. The families of patients with hepatocellular carcinoma included 4,455 siblings of index cases, 7,111 children of male index cases, and 2,947 children of female index cases. The prevalence of hepatitis B surface antigen (HBsAg) was high in groups with high perinatal infection and in men. Gender differences in the prevalence of HBsAg diminished in children of female index cases and siblings of index cases, and in all groups after the age of 60 years. The prevalence of HBsAg declined with increasing age in all groups, with the highest decline in male siblings of index cases ( 1.37% per year) and the lowest in female children of male index cases ( 0.05% per year) in the 35-59 year-old period. Hepatitis C antibody was higher in women (5.7%) than in men (4.0%) in the general check-up group. CONCLUSIONS Females were less susceptible to become HBsAg carriers if HBV was not transmitted during the perinatal period. The prevalence of HBsAg declined significantly in high perinatal infection groups, implying that neonatal tolerance does not endure.