Daily Cannabis Use by HCV+ Increased Odds of Moderate to Severe Fibrosis by 7- Fold
Reported by Jules Levin
57th Annual Liver Meeting (AASLD, American Association for the Study of Liver Diseases)
Oct 27-31, 2006
“Influence of Cannabis Use on Severity of Hepatitis C Disease”
Authors Conclude: “Current daily cannabis use was strongly associated with moderate to severe fibrosis in persons with chronic HCV infection. Our results indicate that HCV-infected individuals should be counseled to reduce or abstain from cannabis use.”
J. H. Ishida1; C. Jin2; P. Bacchetti2; V. Tan3; M. G. Peters1; N. A. Terrault1
1. Medicine, University of California, San Francisco, San Francisco , CA, USA.
2. Epidemiology and Biostatistics, University of California, San Francisco, San Francisco , CA, USA.
3. Pathology, University of California, San Francisco, San Francisco , CA, USA.
Complications of hepatitis C virus (HCV) infection are primarily related to the development of advanced fibrosis. Previously identified risk factors for fibrosis include male gender, older age at HCV infection and heavy alcohol use, but the role of cannabis remains controversial. Cannabis use is prevalent & mouse models indicate a biological basis for a potential effect of cannabis on liver fibrosis.
1. This study objective was to assess the frequency of cannabis use in persons with chronic HCV infection.
2. To determine the association of cannabis use with liver fibrosis severity.
3. To determine whether the association of cannabis use differs by the stage of fibrosis.
Current daily cannabis use independently increased the odds of moderate to severe fibrosis by nearly 7-fold in persons with chronic HCV infection.
--The duration of lifetime moderate to heavy alcohol use was also an independent predictor of moderate to severe fibrosis.
There was no association between current daily cannabis use and mild fibrosis.
--HCV viral load was an independent predictor of mild fibrosis.
The number of portal tracts was associated with both mild & moderate to severe fibrosis, highlighting the importance of controlling for biopsy adequacy.
--The cross-sectional design limits the ability to establish a temporal relationship between cannabis use & fibrosis stage.
--Quantity, duration or method of cannabis use were not assessed in detail.
--Confirm differential effect of cannabis use by severity of disease
--Prospective cohort study of cannabis versus non-cannibas users with chronic HCV infection using more detailed assessments.
This is a cross-sectional study. Between 2001 and 2004, 204 HCV-infected subjects enrolled from university and community sources underwent in-person interviews (to assess demographics, risk factors for HCV, and use of cannabis and alcohol), virologic testing and liver biopsy. Biopsies were scored for fibrosis using the Ishak method (scale F0 to F6) by a single pathologist blinded to clinical data. Biopsy adequacy was assessed by length and number of portal tracts.
Of the 328 subjects enrolled, 204 completed all thebaseline visit requirements, including liver biopsy, and formed the study cohort. Included and excluded subjects were not significantly different except that the former group used cannabis more frequently than the latter group.
The median age of the cohort was 47 years, 69% were male, 49.0% were Caucasian, 61% earned ≤$15,000 per year, 21% were HIV+. 70% had a lifetime history of IVDU (the presumed route of infection was intravenous drug use).
1 drink= 12 oz beer, 4 oz wine, 1 oz liquor
The median lifetime duration and average daily use of alcohol were 29.1 years and 1.94 drink equivalents per day.
Current (within 12 months of enrollment) cannabis use frequency was daily in 13.7%, occasional in 45.1% and never in 41.2%.
Fibrosis stage was F0, F1-2 and F3-6 in 28%, 55% and 15% of subjects, respectively.
The majority of the study cohort participants had stage 0-2 fibrosis and mild inflammation. The median AST & ALT levels were less than 1.2 times the upper limit of normal.
Daily (compared to non-daily or no) cannabis use was strongly associated with moderate to severe fibrosis (F3-6) compared to mild fibrosis (F1-2) in univariate [OR = 3.21 (1.20-8.56), p = 0.020] and multivariate analyses [OR = 6.78 (1.89-24.3), p = 0.003]. But, cannabis was not associated with mild fibrosis in univariate or multivariate analysis. In other words, this study found that patients with moderate to severe fibrosis were 3.21 times more likely to be smoking pot daily compared to individuals who smoked on a non-daily bases; also, for patients who only had mild fibrosis smoking pot daily was not associated. (see tables below).
Predictors of Moderate to Severe Fibrosis (F3-6)
Table 5. Univariate Analysis.
Table 6. Multivariate Analysis
Other independent predictors of moderate to severe fibrosis were lifetime duration of moderate to heavy alcohol use (≥2 and ≥4 drinks per day in women and men, respectively) [OR = 1.72 per 10 years (1.02-2.90), p = 0.044] and ≥11 portal tracts (compared to <5) [OR = 6.92 (1.34-35.7), p = 0.021]. Age was of borderline significance [OR = 2.19 per 10 years (0.95-5.05), p = 0.064].
Predictors of Mild Fibrosis
Daily cannabis use did not appear to be strongly associated with mild fibrosis (F1-2) compared to no fibrosis (F0) in univariate or multivariate analysis. Independent predictors of mild fibrosis were HCV viral load [OR = 1.86 per log10 increase (1.17-2.97), p = 0.009], 5 - <11 portal tracts (compared to <5) [OR = 3.43 (1.59-7.40), p = 0.002] and ≥11 portal tracts (compared to <5) [OR = 10.4 (2.71-40.0), p <0.001].
Table 3. Univariate Analysis
Gender, race, enrollment age, HCV duration and infection source, HCV genotype, HIV, BMI, daily tobacco use, and lifetime alcohol use were not significantly associated with mild fbrosis stage in univariate analysis.
Table 4, Multivariate Analysis
Gender, race, enrollment age, HCV infection duration & source, HCV genotype, HIV, BMI, daily tobacco use, and lifetime alcohol use were not significantly associated with mild fibrosis stage in multivariate analysis.
Not that I am a user of mj, but one shouldn't react to the medicinal value of mj like they're staight of the movie Refer Madness? That kind of thinking is little anachronistic, and quite silly now that we are in the 21st century. If it alleviates sickness that comes with tx, then people can always eat it, if smoking is the issue. headsrtails
Rev, I tend to agree that there are prob a more then a few people who convince themselves that pot is good for what ails you, notwithstanding the fact that it is a drug...and like all drugs, none of them are exactly "good" for your liver. The liver is the main filtering organ and one of it's many duties is filtering out toxins...if the liver is busy fighting the virus, it stands to reason that adding to it's load is probably not "good" for it...how much can you actually get away with before it treats your liver negatively? (while having the virus) who knows for sure.
There are many more studies concering alcohol and the liver. Even after you supposedly SVR, how much probably depends on so many factors, what is the degree of damage youre left with? and so on...there always seems to be a cost/benefit analysis you have to do with this disease...My sister has advanced cirrhosis...they know for sure that any amount of alcohol is dangerous for her, and could perhaps kill her...maybe only 3 drinks, or 10, alcohol can be that toxic for her. With pot, who knows?
My broom is still in the closet, it's grumbling in there, waiting for me to take it out on a test run before the big holiday on the 31st...
Just reading through the info posted in this study there are glaring problems with the study participants, one being most of the study participants drank substantially. We know alcohol causes fibrosis already so how is it they can say it is MJ if the participants were primarily heavy drinkers? On top of that, how many of these people in this so called study smoked cigarettes?
This "study" looks more like anti MJ propaganda than an actual study.
Let them take a group of MJ smokers who do NOT drink alcohol or smoke cigarettes and compare them to non drinking people that do not smoke cigarettes or marijuana if they want to make a legitimate determination of MJ's impact on HCV patients. Now that would make sense and give us some legitimate data unlike this bogus "study"
well thought out Kalio...even the best conrol studies have problems, and this one certainly seems to have problems.... that's not to say that everyone with hep should go buy a good bong and smoke their heads off...ha ha! Just my opinion...I wonder if that synthesized THC makes you as paranoid as the weed? I mean that what pot does to me...would be great to have something to help with nausea, if theres one thing I hate is to be nauseus...
There is a synthesized pill, they gave it to my Mother when she had a stroke. The problem was it was far too strong and didn't help her nausea, only smoking it helped her.
I tried to find your response email, never did. Just wanted you to know I wasn't ignoring you. I give up on that site, it is too confusing and it is always asking me to pay for some upgrade.
That must be where you responded to because I never did get an email at my "regular" addy.
not saying I have any "beef" with you, believe me, youre the last one on here I want any beef with, youre a madman! ha ha! just discussing the pot thing...remember, I try not to personlize arguments here, I only like to discuss issues...this is the internet, and sometimes I think the people who might get on your nerves on here, are the very ones you might get along with in real life...and the ones you might be "chummy" with on here, might work your last nerve in real life...lol..who knows? We're all not sitting in a room with each other anyway...so I don't read too much into all the bickering on here...besides, people are on strong drugs, so I cut them slack, like I hope they'll do with me...we're all fellow travelers with this disease, is how I look at it...
yeah, I still know Brendan, he's got a book of mine he never returned...the little gremlin...he's in a very nice relationship now if you didn't know...so you went to the Mask huh? Glory be...
Your agression is one the reasons that give sites like this a bad name. There is medicicanl value in MJ, so your knee-jerk response is myopic to say the least. And your wise cracks are juvenile? Grow the f***up
What happened to make you reviled? I know you can be pretty bad sometimes, but I have been gone. You have another underslash from being zapped? What happened? Sometimes you can be so good and thoughtful and others such a meany.
I noticed Rocker isn't here either. Anyone else? Please fill me in on the goings on the past couple weeks. Thanks.
Sbaygirl got it right with you, you can be really thoughtful and pretty damned insightful too, then, boy, you can GO OFF!!! And carry a grudge too...have a feeiing youre prob a whole lot nicer in real life...I'm sorry that you've had to treat so long, that can't be great for your nerves or tolerance level...I'm not a big druggie either...why do you think it's soooo dang hard for me to treat? the thought of shootin and swallowin those toxic drugs goes against everything in me...It's so counter-intuitive for me...I'm working on that with my psychiatrist, trying to make myself believe they will do me good...so be nice huh? for awhile? you must be at least heartened by the fact that it looks good in the polls, if you get my drift...
ha ha, Brendan and Janet might take exception to the fact that we are bandying their names all over a hep c site, ha ha! yeah, Monday night New Orleans rice and beans, who could forget that? yeah, I probably dropped more pot at the Zero then most people have ever smoked...
hey Lady Macbeth was only steeling herself up to do well in a man's world...she wanted to play with the big boys...it only looks worse on a woman cause no one expects it...too old for the broom buizzness this year, they gotta Salem Witch Trials tour bus I'm lookin at...
I don't know you either, Scotty. But I never defended potsmoking in the thread, nor do I smoke pot, nor do I care if peole do. Its imbeciles like you why I left California. And Brendan Mullen, are you talking about that hack writer? Is that what you do, drop names because you don't have one? Beam this Scotty
yeah, I remember you, who could forget you? but I'm anonymous on this site, have to be for work reasons...all this dark side stuff you have is a defense mechanism, a little game...youre actually a very nice guy, a little on the sensitive side...I remember, I don't care what you say...
Okay, now you have offended my steak eating habit! I love 'em. I don't inhale, but I do have them sometimes. My theory is whatever I can possibly get down that day, I eat. I don't have an appetite, so if I feel like steak I eat it. Maybe I am a bad treater because of this, but it gets me through this awful stuff.
I can't smoke pot either. Last time I tried one puff I took one step and fell flat on my face. It makes me so anxious, I lay there wondering when it will end. No fun for me. I leave the room if anyone is doing it.
On the other hand, if I couldn't eat or was nauseaus and the only thing that worked was pot in a pill or smoke, I would probably do it and put up with the sx I get from it.
My 78 y/o friend is here today. He always hated drugs and pot. Put anyone down who did them. As he aged and lost too much weight and couldn't eat he started smoking pot. Most days it is the only way he can eat. I can't condemn that one bit.
If I was dying (literally)in pain and the only thing that worked was heroin, I would do it. I am not about to suffer the last days of my life and not use something to help alleve the suffering. I have had too much pain in my life and no I do NOT want to die suffering if I can help it.
Sounds fun down there. Reminds me of my ol' SF days painting album covers and hanging out with Rock stars. I even painted a TV backdrop for the Monkey's once. Dolenz stiffed me when his new show didn't fly. Sure brings back memories....could be why I am where I am today! Hahaha
Girl: Hey, when I talk about diet restrictions or whatever, I mean when youre not treating...I'm fully aware that treating does things to the ole tastebuds...and you eat what you can...some idiot gave me a cannibis cookie at a restaurant (I had no idea) and I gotta panic attack of all panic attacks, went to the ER..thought I was having a heart attack, ain't it grand to be able to laugh at things like that in the afermath? (great Stones album...)
Heads: this is just the way I see it, when I first started coming to boards, if I got insulted, I really took it to heart and got very offended and verbally fought back, etc...and I'm not saying I never will again...but after I'd been around for awhile, I just put it together it's the internet, and I don't take stuff like that too seriously...Are they paying my bills or responsible for me in any way?....then why pay too much attention....Most people reading with any sense at all know what's what....Especially people on meds doing it...and I find when I don't take it too seriously, it doesn't get too serious if you know what I mean...it's different if someone is hounding you from thread to thread, that's more than irritating and I understand the frustration there...this is just my take...
What would I do if I couldn't add an ending to your nickname? LOL
Of course this is name calling too, but we know I am joking around. Those that work on being diplomatic seem to get along better, of course, this doesn't always work either! LOL John always comments on "Linda's school of diplomacy," meaning I don't have one! I too was offended by some rude posters, and still am, but as you say what can we do about it? Remind others to be nice and newbies not to be insulted and hurt? Yeah, but some leave anyway not liking the tone that hits the board sometimes.
I know what you mean about the food and I hope when I grow up I can eat no meat, but I do love my veggies! My diet has deteriorated on tx for sure. I never ate sweets! My stomach didn't stick out. Now it does! As my granddaughter says,"I can't like that!"
I had to stop the chocolate cake 'cuz john was getting fatter too! You will see when you start tx..it's really strange how food preferences change. When are you going to start anyway? Trial?
I agree with SBgirl...for the good of the board, I wish people wouldn't keep up feuds... then move on though sometimes a feud can be kept up by one person...we have to remember that sometimes people just get disgusted by one another, then later on they are best buds, this is the internet and I've seen that more then a few times on this board...I just hate to see character assinations, it leaves a bad taste..
There are few people on here who have never made a mistake, a lapse in judgment, etc...and sometimes people just get off on the wrong foot with one another for no good reason...
I come here to get support, gather info and have a laugh once in awhile, and sometimes get involved in interesting discussions that I can learn from...this is a Hep C board, not West Side Story...just my opinion...
That is not it at all; read the posts; who got nasty first? And I dont even smoke pot. I was defending the medicinal value of mj, doctors have understood its medical potential, does anyoe here have a medical degree to refute that? I don't shoot heroin, but when I was in a near fatal car accident I am glad I got a dose of morphine; you re going to refute that too because you are so anti-drug that it is irrational? In a previous post, Mr. Revenies, you mentioned you were about to cook steaks. From what I understand, that diet is bad because of the high iron content. If rochammer was here, he would let you have it on that one just beacuse he does not reat red meat. The differnec between him and your response is that he is more mature in his refutation and does not take it to a personal level. Did anyone try to contradict you about your right to your steak-eating, regardless if it being a potential detriment to tx? Then why would you go on a tirade about potsmoking? Hypocrosy is really one of the worst traits.
man, there are the SBaygirls, and the SFbaygirls, you guys are REPRESENTIN on this thread, ha ha! I had asked about you awhile back, I was wondering about you...I'm kicking and screaming, but I'm gonna run that dang interferon if it kills me (better not jinx it) I'm glad youre doing well...you sound like you have such a nice relationship with youre hubby...prob comes in handy on those meds...be well
Yes, having a good relationship with John has been a bit tuff on tx, that's for sure. When I am angry at him, he laughs and says, "oh riba rage again?" Not realizing I am DEAD serious! Grrrrr....Or I love when he doesnt' trust what I say now, because of Brian Fog. Should have never told him about that guy! LOL Good thing we go to therapy.
You better get on that stuff Girl, or I'm gonna have to come down there and drag you to the clinic! hahahaha
How's the teen life? My teen is about to drive me round the bend...can't wait for college!
Monterey, Phoenix and this week Tahoe...at least I get some exercise in airports...Hey, I got on the exercise bike this week and did it! I am so proud! Things seem to be getting easier on tx, I guess I am getting use to the poison.
If you don't like pot, don't smoke it. if you do, smoke it b/c it can help you.
everything is a poison now days. the air is poison, the water is poison, the veggies, meat and fish are poison. AD's are poison that some people can never get off of.
Emotions-negative emotions about anything are poisons. not enough sex is poison and raises blood pressure.
Mother's breast milk is poison, sperm is poisoned. out blood and bodies hold lead, florides, pcps and flame retardents in 'mind damaging' amts.
So Choose Your Poisons wisely.
clean up your diet and the clothes and the lotions you put on yopur body-they are all poisoned. transfats and perservatives and food dyes made from insect parts are poison. Corn syrup and colas are poison.
hatred and racism and war are poisons. the chemicals made by our own bodies in association w/negative emotions andd stress are poisons. North Korea put more neuclear poison in the air than a life time of smoking pot can ever come close to.
And there are no studies currently being done on the medical effects of marijuana. only things coming out about marijuana are 'accidental' findings-like pot stops Alzeheimers and slows lung cancer and helps hcv patients achieve svr.
If pot was so bad, I think we would have studies coming out of the Netherlands saying it is b/no we don't b/c there aren't any.
So if you don't like it, don't use it. If you can use it, use it b/c it c can help-alot.
funny how I don't agree with many of your analogies as any kind of proof of your main position...but I do think it was nicely written...once again, our bodies are so different..I kinda regret that I was a big pothead in my early twenties, because for me, it almost completely wiped out my memories in the span of time I used it a lot...and since I'm in my early fifties now, I'd sure like to access those memories now...but that particular span of time is a haze, shall we say...oddly, once I quit smoking it, I can access those memories much better...
Memories are extremely important to me, so you can see why I'm not singing the praises of the stuff, plus it began to make me as paranoid as hell...(though I do remember how it enhanced music for me, though maybe that's just something I thought at the time, because now I find myself appreciating music just as much as anytime in my life)
There have been some studies talking about how pot can wipe out long term and short term memories for some people, though not all...I do agree with your premise that people can basically do what they want with their own bodies... if someone wants to shoot heroin with liver disease, it's their basic right...I just think part of the function of these boards is to put these issues up for discussion, hopefully with opinions on both sides of the issue, so we can make up our own minds about them...and of course I have an often irritating "mother hen" personality, so I would advocate against people hurting themselves...it's all relative, many people would submit that I've been hurting myself putting off treatment for so long, so there you go...
I am for medical marajuna use, on a case by case basis...
I have a good friend that refuses to even try mj because as she says, O god, I'd never do that !! She's treating breast cancer and doing radiation and kemo, and I guess I just don't get folks that are so against a drug, that they wont even try it, even when it helps them !! No one will be able to convince me that mj does not help with those side effects. I watched my bro-in-law die last yr of cancer, and mj helped him more than the morphine, and other potent pain killers. I'm vapeing my cannabis these days, and I can tell you that just that makes a big difference in your breathing. Smoking anything is bad. As for the fibrosis claim, I don't believe cannabis causes anything in anybody, even if you ate a trash can full of it. Like I say, smoking anything is bad news ! People 50 yrs. from now will say,' Damm,' remember when them fools used to smoke pot and cigs. !! But anyhow, this is my 1st. post here, and it sounds like people here are letting personalities. get in the way of fighting hepc. I come here looking for a place to discuss hepc tx, and socialize a bit. But I can't converse with anyone who is so dead set against something, that they would refuse that treatment, knowing it might help them. Delphia forums don't allow mention af any drug except prescription meds., so I'm looking for a new place to hang my hat. i'm not here to be for or against pot, but I defend my right to use it. And forseegood, who's going to be doing the decision making in your case by case sanario ? I been smoking pot most of my life and you'd think the people on your case by case panel would know the alcohol caused my problems, not pot. I'm a 70 y o young m, who took my 2d. dose of interferon today. No sides yet. I am geno type 1, and doing tx for 24 weeks. I can definately say insommia is a problem already, I'm usually in bed lights out asleep by 10 pm.
yes thank you, that's what happens when you're 1/2 asleep from these nasty drugs !!
Took my 2d. dose on interferon yesterday, so far, no sides, except insommia.
Hope everyone feels just a little better than yesterday.
My gastroenterologist ordered me to not smoke pot even though it is prescribed for HCV in Michigan. His reason was that it can raise the risk of liver cancer. I believe that a lot of older doctors are simply anti-medical pot. Anyway, he is helping me get tx affordably and I will abide by his orders.
One very real reason to not smoke pot if you have ESLD is that it can be a reason to disqualify your from getting a transplant. You can be disqualified if you are not clean of both mj and alcohol for 6 months.
If you are not in need of a liver transplant, then my renown hepatologist in S.F. has no objections to doing it. He is agreeable to most anything ( though not everything) if it helps you get through tx.
I've been punk'd again by an ancient post at the top of the list! I would not recommend that anyone looking for relevant study data waste time on a 2006 post, unless it's a history project comparing old beliefs with new beliefs. Orphanedhawk's comment regarding her hepatologist's thoughts is a far more reliable source. Just my personal opinion.
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