title: Marijuana Use Is Not Associated With Progression to Advanced Liver Fibrosis in HIV/Hepatitis C Virus-coinfected Women.
abstract: Marijuana (hereafter "tetrahydrocannabinol [THC]") use has been associated with liver fibrosis progression in retrospective analyses of patients with chronic hepatitis C (HCV). We studied long-term effects of THC on fibrosis progression in women coinfected with human immunodeficiency virus (HIV)/HCV enrolled in the Women's Interagency HIV Study (WIHS).
  
  
  
  Liver fibrosis was categorized according to FIB-4 scores as none, moderate, or significant. THC and alcohol use were quantified as average exposure per week. Associations between THC use and progression to significant fibrosis were assessed using Cox proportional hazards regression.
  
  
  
  Among 575 HIV/HCV-coinfected women followed for a median of 11 (interquartile range, 6-17) years, 324 (56%) reported no THC use, 141 (25%) less than weekly use, 70 (12%) weekly use, and 40 (7%) daily use at WIHS entry. In univariable analysis, entry FIB-4 score (hazard ratio [HR], 2.26 [95% confidence interval {CI}, 1.88-2.73], P < .001), log HCV RNA (HR, 1.19 [95% CI, 1.02-1.38], P = .02), tobacco use (HR, 1.37 [95% CI, 1.02-1.85], P = .04), CD4(+) count (risk per 100-cell increase: HR, 0.90 [95% CI, .86-.95], P < .001), and log HIV RNA (HR, 1.18 [95% CI, 1.05-1.32], P = .005) were associated with progression to significant fibrosis, as was cumulative alcohol use in follow-up (HR, 1.03 [95% CI, 1.02-1.04], P < .001). In multivariable analysis, entry FIB-4, entry CD4(+) count, and cumulative alcohol use remained significant. Cumulative THC use was not associated with fibrosis progression (HR, 1.01 [95% CI, .92-1.10], P = .83).
  
  
  
  In this large cohort of HIV/HCV-coinfected women, THC was not associated with progression to significant liver fibrosis. Alcohol use was independently associated with liver fibrosis, and may better predict fibrosis progression in HIV/HCV-coinfected women.
authors.affiliation: Department of Medicine, University of California, San Francisco Department of Medicine, University of Ottawa, Ontario, Canada.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Kelly
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodge
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Monika
authors.initials: M
authors.lastname: Sarkar
authors.affiliation: Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois.
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.affiliation: Department of Medicine, University of California, San Francisco Department of Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.affiliation: Infectious Diseases, Weill Cornell Medical College, New York, New York.
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.affiliation: Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn;
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.affiliation: Department of Medicine, Georgetown University Medical Center, Washington D.C.
authors.forename: Michael
authors.initials: M
authors.lastname: Plankey
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D015331:Cohort Studies; D060085:Coinfection; D018450:Disease Progression; D005260:Female; D006678:HIV / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D008137:Longitudinal Studies; D000074609:Marijuana Use; D011446:Prospective Studies
keywords: HCV; HIV; liver fibrosis; marijuana; women