After the success of the Hot Topics in Viral Hepatitis issue entitled, “Women in Hepatology,” published in 2011, we thought it was appropriate to provide an update on sex-related issues in hepatology. This issue will cover diverse topics. Three articles deal with the impact of sex hormone status on liver fibrosis progression and the virological response to antivirals in patients with chronic hepatitis C. Menopause is a clear watershed event in a woman’s life, affecting clinical and histological end points of various chronic liver diseases— not just hepatitis C. In addition, the rate of response to antiviral therapy may be drastically reduced as soon as women enter menopause. This scientifically challenging topic is described in detail by Mangia, Villa, and Bernabucci and Turco in 3 interrelated chapters.
Then, Berzigotti and her colleagues from Barcelona describe the impact of obesity on liver disease progression: this is quite a timely subject, due to the alarming spread of the metabolic syndrome globally. Sex-specific aspects of the relationship between obesity and liver diseases are also discussed, although research in this field still warrants further studies: the increase in visceral adiposity in postmenopausal women is just an example of the intricate link between sex hormones and metabolism that needs to be elucidated.
Finally, the issue closes focusing on the molecular pathogenesis of hepatocellular carcinoma, suggesting some unconventional approaches to therapy. The incidence of this ominous human cancer is up to 4 times higher in men than it is in women, indicating that sex hormones—and not just a different sex-specific exposure to exogenous risk factors—are important, direct players in liver oncogenesis. Thus, there is another example of where the progression from fertility to menopause may have a dramatic impact on the prognosis of women affected by chronic liver diseases. I take this opportunity to thank all the authors for participating in this challenging debate, and in particular Erica Villa for her unabated enthusiasm to promote it.