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Beware Pot Users...Cannabis is not liver friendly!

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
Boston, MA

“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.
42 Responses
Avatar universal
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.

STUDY OBJECTIVES
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.

AUTHOR CONCLUSIONS
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.

Limitations
--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.

Future Directions
--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.

Methods:
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.

Results:
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).

Baseline Characteristics

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.








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Avatar universal
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
86075 tn?1238118691
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...
Avatar universal
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"

86075 tn?1238118691
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...
86075 tn?1238118691
oh, haven't smoked any pot since the 80's, the last couple of times it gave me huge anxiety attacks...
Avatar universal
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.

86075 tn?1238118691
that is so weird...I responded to two different emails in your post and they never were bounced back...i'll look into it once I have the time...
131817 tn?1209532911
Does that mean a horse is a horse of course...unless he smokes pot?
86075 tn?1238118691
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...
Avatar universal
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
131817 tn?1209532911
Hey Rev,

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.
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