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Daily Cannabis Smoking Linked With Increased Steatosis Severity

     Information from Industry

By Will Boggs, MD

NEW YORK (Reuters Health) Mar 05 - 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.