title: Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C.
abstract: Cannabinoids present in Cannabis sativa (marijuana) exert biological effects via cannabinoid receptors CB1 and CB2. We recently demonstrated that CB1 and CB2 receptors regulate progression of experimental liver fibrosis. We therefore investigated the impact of cannabis smoking on fibrosis progression rate in patients with chronic hepatitis C (CHC). Two hundred seventy consecutive untreated patients with CHC of known duration undergoing liver biopsy were studied. Demographic, epidemiological, metabolic, and virological data were recorded, and detailed histories of cannabis, alcohol, and tobacco use over the span of hepatitis C virus infection were obtained. Fibrosis stage, steatosis, and activity grades were scored according to Metavir system. Patients were categorized as noncannabis users (52.2%), occasional users (14.8%), or daily users (33.0%), and the relationship between cannabis use and fibrosis progression rate (FPR) or fibrosis stage was assessed. On multivariate analysis, six factors were independently related to a FPR greater than 0.074 (median value of the cohort): daily cannabis use (OR = 3.4 [1.5-7.4]), Metavir activity grade A2 or higher (OR = 5.4 [2.9-10.3]), age at contamination of more than 40 years (OR = 10.5 [3.0-37.1]), genotype 3 (OR = 3.4 [1.5-7.7]), excessive alcohol intake (OR = 2.2 [1.1-4.5]), and steatosis (OR = 2.0 [1.0-4.1]). Daily cannabis use was also an independent predictor of a rapid FPR (>0.15) (OR = 3.6 [1.5-7.5]). Finally, severe fibrosis (> or =F3) was also predicted by daily cannabis use (OR = 2.5 [1.1-5.6]; P = .034), independently of Metavir activity grade, excessive alcohol intake, age at liver biopsy, steatosis, and tobacco smoking. In conclusion, daily cannabis smoking is significantly associated with fibrosis progression during CHC. Patients with ongoing CHC should be advised to refrain from regular cannabis use.
authors.affiliation: Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris XII, Créteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hézode
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Son
authors.initials: S
authors.lastname: Nguyen
authors.forename: Pascale
authors.initials: P
authors.lastname: Grenard
authors.forename: Boris
authors.initials: B
authors.lastname: Julien
authors.forename: Elie-Serge
authors.initials: ES
authors.lastname: Zafrani
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlotsky
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlostky
authors.forename: Daniel
authors.initials: D
authors.lastname: Dhumeaux
authors.forename: Sophie
authors.initials: S
authors.lastname: Lotersztajn
authors.forename: Ariane
authors.initials: A
authors.lastname: Mallat
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D002189:Marijuana Abuse / Q000150:complications*; D008385:Marijuana Smoking / Q000009:adverse effects*; D012307:Risk Factors