Marijuana Use Is Not Associated With Progression to Advanced Liver Fibrosis in HIV/Hepatitis C Virus–coinfected Women

Abstract

Background. Marijuana (hereafter "tetrahydrocannabinol [THC]") use has been associated with liver fibrosis progression in retrospective analyses of patients with chronic hepatitis C (HCV). We studied long-term effects of THC on fibrosis progression in women coinfected with human immunodeficiency virus (HIV)/HCV enrolled in the Women's Interagency HIV Study (WIHS).Methods. Liver fibrosis was categorized according to FIB-4 scores as none, moderate, or significant. THC and alcohol use were quantified as average exposure per week. Associations between THC use and progression to significant fibrosis were assessed using Cox proportional hazards regression.Results. Among 575 HIV/HCV-coinfected women followed for a median of 11 (interquartile range, 6-17) years, 324 (56%) Conclusions. In this large cohort of HIV/HCV-coinfected women, THC was not associated with progression to significant liver fibrosis. Alcohol use was independently associated with liver fibrosis, and may better predict fibrosis progression in HIV/HCVcoinfected women.

Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis

“…Early studies mostly rationalized with the fact that HCV was associated with a significant induction in hepatic CB-1 receptor expression [ 30 ]. However, later studies between 2013 and 2016 among HCV [ 16 ] or HCV+HIV [ 15 , 17 ] coinfected individuals concluded that cannabis had no effect on liver disease from HCV. Although these three newer studies had larger samples sizes (550, 575, and 690 subjects), they did not eliminate many chronic liver diseases from diverse etiologies.…”

“…However, the relationship between cannabis use and HCV has been controversial and remains unclear. While earlier studies suggested that cannabis use resulted in increased steatosis, fibrosis, and worsening of HCV disease [ 12 – 14 ], recent observations are now advancing that cannabis use has no effect on HCV disease progression [ 15 – 17 ]. A recent reports even revealed that cannabis use was associated with reduced steatosis in HCV infected individuals [ 18 ].…”

Cannabis and the Gastrointestinal Tract

“…Stimulation of CB2 receptors, which may be upregulated in chronic liver disease (57) have been reported to protect against hepatic fibrosis (58). Curiously, in ALD, the balance of cannabinoids may have a potential protective effect by reducing oxidative stress that leads to inflammation and steatosis (59) thereby resulting in lower rates of alcohol-induced steato-hepatitis, and cirrhosis (60).…”

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

“…Patients coinfected with HIV were excluded from one of these studies [23], while they represented 21% of patients included in the second study [24]. By contrast, two large longitudinal cohort studies conducted in 690 and 575 HIV-HCV coinfected patients showed no significant relationships between cannabis use and liver fibrosis [25,26]. Moreover, two recent populationbased studies conducted in the USA with large study samples showed an inverse relationship between cannabis use and NALFD [27,28].…”