Daily cannabis and reduced risk of steatosis in human immunodeficiency virus and hepatitis C virus‐co‐infected patients (ANRS CO13‐HEPAVIH)

Abstract

Liver steatosis is common in human immunodeficiency virus (HIV)-hepatitis C virus (HCV)-co-infected patients. Some recent studies have found that cannabis use is negatively associated with insulin resistance in the general population and in HIV-HCV-co-infected patients. Given the causal link between insulin resistance and steatosis, we hypothesized that cannabis use has a positive impact on steatosis. Therefore, we aimed to study whether cannabis use in this population was associated with a reduced risk of steatosis, measured by ultrasound examination. ANRS CO13-HEPAVIH is a French nationwide multicentre cohort of HIV-HCV-co-infected patients. Medical and socio-behavioural data from clinical follow-up visits and annual self-administered questionnaires were prospectively collected. A cross-sectional analysis was conducted using data from the first visit where both ultrasound examination data for steatosis (positive or negative diagnosis) and data on cannabis use were available. A logistic regression model was used to evaluate the association between cannabis use and steatosis. Among study sample patients (n = 838), 40.1% had steatosis. Fourteen per cent reported daily cannabis use, 11.7% regular use and 74.7% no use or occasional use ("never or sometimes"). Daily cannabis use was independently associated with a reduced prevalence of steatosis (adjusted odds ratio [95% CI] = 0.64 [0.42;0.99]; P = .046), after adjusting for body mass index, hazardous alcohol consumption and current or lifetime use of lamivudine/zidovudine. Daily cannabis use may be a protective factor against steatosis in HIV-HCV-co-infected patients. These findings confirm the need for a clinical evaluation of cannabis-based pharmacotherapies in this population. Eudract.ema.europa.eu number, DGS050367.

Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease

“…We observed that although the impact was less when compared to individuals without HCV, cannabis use still resulted in a reduced risk for AH, AC and HCC among alcoholics with HCV infection (Table ). A recent study showed that cannabis use is associated with decreased steatosis among individuals with HIV/HCV co‐infection . Numerous mechanisms have been described by which HCV synergizes with alcohol to accelerate liver disease including HCV‐mediated upregulation of CB‐1 receptors in hepatic stellate cells, promoting pro‐fibrotic stellate cells.…”

“…A recent study showed that cannabis use is associated with decreased steatosis among individuals with HIV/HCV co-infection. 56 Numerous mechanisms have been described by which HCV synergizes with alcohol to accelerate liver disease including HCVmediated upregulation of CB-1 receptors in hepatic stellate cells, 57 promoting pro-fibrotic stellate cells. However, our observations of reduced AH, AC and HCC in HCV-infected alcoholic who use cannabis might suggest CBD 19,58 in cannabis antagonize CB-1 19 receptors activation.…”

Cannabinoids and reduced risk of hepatic steatosis in HIV-HCV co-infection: paving the way for future clinical research

“…In a non-negligible proportion of patients therefore, steatosis lesions may persist after HCV eradication and influence the risk of fibrosis and hepatocellular carcinoma in this population [16]. Hepatic steatosis is present in 30-70% of HIV-HCV coinfected patients [17][18][19] and aggravates hepatic lesions [9].…”

“…There is very little literature concerning the association between cannabis use and hepatic steatosis in this population. A recent study including 838 coinfected patients showed a significant relationship between daily cannabis use and a reduced risk of steatosis (screened for by ultrasound examination), after adjustment for body mass index, alcohol consumption and exposure to certain antiretroviral agents [18]. Most patients had a history of injecting drug use and a quarter of them were HCV cleared.…”

“…To our knowledge, to date only one study has analyzed the relationship between cannabis use and hepatic steatosis in HIV-HCV coinfected patients [18]. Available data on cannabis use and hepatic steatosis in other populations are based on cross-sectional studies and show contrasting results.…”