Clinical

Daily cannabis smoking linked with increased steatosis severity

Last Updated: 2008-03-05 12:33:15 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Daily marijuana smoking is associated with increased severity of steatosis in patients with chronic hepatitis C, according to a report in the February issue of Gastroenterology.

"Information about cannabis use should be routinely obtained, and the patients need to be advised of the potential deleterious effects of cannabis on hepatitis C outcome," Dr. Ariane Mallat from Groupe Hospitalier Henri Mondor-Albert Chenevier, Creteil, France told Reuters Health.

Because endocannabinoids have promoted steatosis in experimental models by activating hepatic CB1 receptors, Dr. Mallat and colleagues investigated the relationship between cannabis use and steatosis grade in patients with untreated chronic hepatitis C undergoing liver biopsy.

Nearly a third of the daily cannabis smokers had marked steatosis, compared with 7.7% of occasional cannabis users and 16.0% of nonusers, the authors report.

In logistic regression analysis, daily cannabis use was associated with a doubling of the rate of marked steatosis, whereas occasional use had no significant effect.

The association between daily cannabis use and marked steatosis was independent of viral genotype and persisted after adjustment for alcohol intake.

Not surprisingly, the researchers point out that "cannabinoid use should be discouraged in patients with chronic hepatitis C."

Furthermore, Dr. Mallat said, "This study makes a strong point supporting the potential beneficial effect of CB1 antagonism in the treatment of nonalcoholic fatty liver disease."

In a related editorial, Drs. George Kunos and Bin Gao from the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland write that given these "very interesting findings...clinical trials testing the effectiveness of a CB1 antagonist in combination with antiviral interferon treatment in patients with chronic hepatitis C virus complicated by steatosis and fibrosis may be warranted."

"We are currently investigating the impact of cannabis use on insulin resistance (metabolic and virus-induced) in patients with hepatitis C," Dr. Mallat added.

Gastroenterology 2008;134:432-439,622-625.