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

Abstract

Background and Aim The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.

Cannabis use is associated with a lower risk of diabetes in chronic hepatitis C‐infected patients (ANRS CO22 Hepather cohort)

“…Accordingly, we found that advanced liver fibrosis is a risk factor for diabetes. Based on a large database of USA hospital discharge records, Adejumo et al found that cannabis use was associated with a lower prevalence of liver cirrhosis among chronic HCV‐infected patients 20 . Among users, while the difference was not statistically different, dependent users had an even lower prevalence of liver cirrhosis than nondependent users.…”

“…19 In chronic HCV-infected patients, cannabis use was also associated with better liver disease outcomes. 20 However, there is still a lack of data regarding the association between cannabis use and the risk of type 2 diabetes in HCV mono-infected patients. Using data from the French ANRS CO22 Hepather cohort, we aimed to test whether cannabis use is inversely associated with type 2 diabetes in HCVinfected patients.…”

“…In a cross‐sectional analysis of HIV‐HCV co‐infected patients, cannabis use, irrespective of frequency, was associated with lower odds of insulin resistance after adjustment for known confounders 19 . In chronic HCV‐infected patients, cannabis use was also associated with better liver disease outcomes 20 . However, there is still a lack of data regarding the association between cannabis use and the risk of type 2 diabetes in HCV mono‐infected patients.…”

Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome

“…Additionally, cannabis is increasingly being studied for its utility in several medical conditions and has also shown promising results in many of these studies. 12,[29][30][31][32][33][34] Cannabis has shown usefulness for gastrointestinal disorders such as irritable bowel syndrome, Crohn's disease, and ulcerative colitis by alleviating nausea and optimizing nutritional status. [35][36][37][38] Another reason for the increase in cannabis use is the changes in public perception regarding cannabis.…”

Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States

“…1 and Supplementary Table 1). The ICD-9-CM code for NAFLD has been used by many recent studies [15][16][17][18][19][20]. We also eliminated records with missing inputs, and abstracted demographic, patient, and hospital-related information.…”