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Smoking Marijuana Raises Fibrosis Risk in Patients With Chronic Hepatitis C Infection: Presented at AASLD

By Mark L. Fuerst

BOSTON, MA -- November 2, 2004 -- Daily marijuana smokers who have chronic hepatitis C infection risk having rapid progression of liver fibrosis, according to research presented here October 31^st at the 55^th Annual Meeting of the American Association of Liver Diseases.

Cannabis, the active ingredient in marijuana, exerts its biological effects through the binding of two receptors, CB1 and CB2. Ariane Mallat, Professor in the Hepatology and Gastroenterology Service at the Henri Mondor Hospital, Creteil, France, and colleagues previously demonstrated that CB1 receptors enhance fibrogenesis in mice, and set out to evaluate the clinical relevance of this finding in patients with chronic liver disease.

In 211 subjects with ongoing chronic hepatitis C infections, the researchers collected data on demographics, route of transmission, age at exposure, duration of hepatitis C virus infection, intakes of alcohol, tobacco, and cannabis over the course of the disease, maintenance treatment with methadone or buprenorphine, body mass index, fasting glucose level, genotype, steatosis, histological activity, and fibrosis level and progression.

Responses show that 32.2% of patients had used marijuana daily since the beginning of their disease (mean duration of 16 years), 16.6% were occasional smokers (once every other week), and 51.2% never smoked marijuana.

Univariate analysis showed that two-thirds of the daily smokers had a rapid rate of fibrosis progression compared to 40% of occasional smokers and 41% of non-smokers. In a multivariate analysis, a rapid fibrosis progression rate was related to daily cannabis use (odds ratio [OR] = 4.0), as was excessive daily alcohol intake (30 g; OR = 2.1), age at exposure of more than 24 years (OR = 4.8), and genotype 3 (OR = 3.1). There was no increased risk of progression among occasional smokers compared to non-smokers.

"In chronic hepatitis C infection, there is a strong relationship between daily cannabis use and fibrosis progression rate," Dr. Mallat said. "Patients with ongoing chronic hepatitis C should be advised against daily cannabis use, since regular use over the span of the disease is an aggravating factor regarding fibrosis progression."

This study supports the experimental data that demonstrated the profibrogenic role of CB1 receptors, she said, and noted that patients with chronic liver disease have a large amount of CB1 receptors in the liver, and that the impact of marijuana smoking is as a cofactor, and is not responsible for liver fibrosis per se.


[Presentation title: "Daily Cannabis Smoking as a Risk Factor for Fibrosis Progression in Chronic Hepatitis C." Abstract 67]

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