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CANNABIS USE AS AN INDEPENDENT PREDICTOR OF SEVERE STEATOSIS DURING CHRONIC HEPATITIS C
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Reported by Jules Levin
EASL, April 11-15, 2007
Barcelona, Spain
C. Hezode 1,2, E.S. Zafrani 3, F. Roudot-Thoraval 2,4, C. Costentin 1, A. Hessami 3, J.M. Pawlotsky 2,5, S. Lotersztajn 6, A. Mallat 1,6
1 Department Of Hepatology, Hopital Henri Mondor, Creteil, France; 2 INSERM U635, Hopital Henri Mondor, Creteil, France; 3 Department Of Patology, Hopital Henri Mondor, Creteil, France; 4 Department Of Public Health, Hopital Henri Mondor, Creteil, France; 5 Department Of Virology, Hopital Henri Mondor, Creteil, France; 6 INSERM U581, Hopital Henri Mondor, Creteil, France
We recently found a significant relationship between daily cannabis use and fibrosis severity in chronic hepatitis C (CHC). Cannabis Sativa binds two receptors, CB1 and CB2, and recent experimental data suggest that activation of CB1 receptors increases steatogenesis (Osei-Hyiaman et al, J Clin Invest 2005). The aim of the present study was therefore to evaluate the impact of cannabis use on steatosis severity during CHC.
311 consecutive naïve patients with histologically proven chronic hepatitis C were included. Parameters recorded were epidemiological data, intakes of cannabis, alcohol, tobacco and maintenance treatment over the semester preceding biopsy, BMI, diabetes, serum fasting glucose, triglycerides and cholesterol levels. Degrees of steatosis, activity and fibrosis (METAVIR) were histologically assessed by two pathologists without knowledge of clinical data, and marked steatosis was defined as >30%.
Patients (220 men, 91 women, mean age: 45+11 yrs) were grouped according to cannabis use: non smokers (59%), occasional smokers (less than one joint daily: 15%, median number of joints/month= 4) and daily smokers (at least one joint daily: 26%, median/month=75).
In unadjusted analysis, marked steatosis was related to cannabis use (16.3% in non smokers, 10.9% in occasional users and 30.9 % in daily users, p=0.006), BMI >27 kg/m2 (29.5 % versus 15.9 %, p=0.008), maintenance treatment (39.1% versus 17.7%, p =0.01), alcohol =30 g/day (35.7% versus 16.7%, p=0.004), genotype 3 (40.0 % versus 13.9%, p<0.001), hyperglycemia (50.0 % versus 20.0 %, p<0.001), activity =A2 (25.4 % versus 10.8 %, p=0.001) and fibrosis =F2 (29.1% versus 13.9%, p=0.003).
By multivariate analysis, independent predictors of marked steatosis included daily cannabis use (OR=2.13; 95%CI: 1.04-4.37) activity =A2 (OR=2.40; 95%CI: 1.18-4.84), genotype 3 (OR=4.41; 95%CI 2.17-8.95) and hyperglycemia (OR=6.83; 95%CI: 2.52-18.5).
In conclusion, this study discloses a strong link between daily cannabis use and steatosis severity in patients with CHC and supports recent experimental data demonstrating steatogenic effects of CB1 receptors. These observations and our previous results showing that daily cannabis smoking is also an independent predictor of fibrosis progression, indicate that patients which untreated CHC should be advised to refrain from daily cannabis use.
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