Background & Aims:Steatosis is highly prevalent in patients with chronic hepatitis C (CHC) and has been reported to increase fibrosis and reduce the rate of viral eradication. Two recent studies indicate that endocannabinoids promote experimental steatosis via activation of hepatic CB1 receptors. We therefore investigated the impact of cannabis smoking on steatosis severity during CHC. Methods: A total of 315 consecutive patients with untreated CHC undergoing liver biopsy were included. Detailed histories of recent cannabis, alcohol, and tobacco use were recorded. Steatosis, activity, and fibrosis stage were assessed by 2 pathologists according to METAVIR. Marked steatosis was defined as ≥30%. Patients were categorized as cannabis nonusers (63.5%), occasional cannabis smokers (12.4%), or daily cannabis smokers (24.1%). Results:Multivariate analysis identified 6 predictors of marked steatosis: daily cannabis use (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.01–4.5]), activity grade ≥A2 (OR, 2.1; 95% CI, 1.0–4.3), genotype 3 (OR, 5.4; 95% CI, 2.6–11.3), hyperglycemia or diabetes (OR, 5.1; 95% CI, 1.8–15.0), body mass index >27 kg/m2 (OR, 2.1; 95% CI, 1.0–4.3), and serum HCV RNA load (OR, 1.7; 95% CI, 1.0–2.9). Upon adjustment of HCV genotype (3 vs non-3) or alcohol intake (<30 g/day vs ≥30 g/day), marked steatosis was more frequent in daily cannabis users compared with occasional users and nonusers (P = .03 and P = .008, respectively). Conclusions: Our results identify daily cannabis smoking as a novel independent predictor of steatosis severity during CHC and strongly argue for a steatogenic role of the cannabinoid system. Cannabis use should be discouraged in patients with CHC.
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Patients
Consecutive patients were recruited in a single tertiary care center between May 2003 and June 2006 if they met the following criteria: (1) HCV infection defined by a positive test for anti-HCV antibodies (Ortho HCV 3.0 ELISA test system; Ortho Clinical Diagnostics, Raritan, NJ) with detectable serum HCV RNA (Amplicor HCV 2.0 PCR test system; Roche Molecular Systems, Pleasanton, CA) documented for at least 6 months, (2) available liver biopsy specimen (15 mm or greater, with at least 6 portal
Study Population
Table 1 summarizes baseline characteristics of the overall study population (n = 315). There were 223 men and 92 women with a mean age at liver biopsy of 45.1 ± 10.9 years and an average BMI of 24.8 kg/m2. Ongoing alcohol abuse was reported by 13.3% of patients. Intravenous drug use was the most common route of transmission (44.1%). Genotype distribution showed a predominance of genotype 1 (62.5%), followed by genotype 3 (21.0%). Activity grade ≥A2 and significant fibrosis (≥F2) were found in
Discussion
Control of comorbidities is currently considered a desirable goal in patients with CHC, particularly in difficult-to-treat patients. A large majority of studies have repeatedly shown that steatosis is an independent predictor of liver fibrosis progression in these patients.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 In addition, steatosis is an established factor of poor response to antiviral therapy, particularly in patients infected with non-3 genotypes.1, 10, 30 In the present study, we
Hepatitis C virus-induced hepatocellular steatosis
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2023, Cannabis Use, Neurobiology, Psychology, and Treatment
In Europe, France holds a particular position due to the high prevalence of recreational cannabis use in the general population for a long time. As in other countries, the tetrahydrocannabinol content considerably increased these past 10 years. The rate of adverse events of recreational cannabis reported to the French Addictovigilance Network rose with a threefold increase between 2012 and 2017. Many adverse events (AEs) were shown, mainly affecting the central nervous system, the cardiovascular system and the gastrointestinal tract. Given the high prevalence of cannabis use in France, particularly among adolescents and young adults, and the description of unusual clinical presentations in this population, there is concern that serious AEs likely to be underdiagnosed occur. Recently, the pandemic COVID-19 induced modification of consumption practices. In addition, over the same period, emerged cannabis dealing adulterated with synthetic cannabinoid receptor agonists. Both may aggravate the risk of AEs.
2020, Complementary Therapies in Clinical Practice
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In addition, a cautionary note is recommended in patients with cardiovascular disease [30]. Cannabinoids may promote fatty liver disease and should be avoided in patients with chronic hepatitis C [34]. In patients with impaired liver or kidney function, the effect of THC and CBD may be increased or prolonged.
1) to evaluate the efficacy of medical cannabinoids (MC) by appraising the quality of evidence from clinical studies 2) to explore the factors hampering the MC use in clinical practice of Parkinson's disease (PD).
We performed a systematic review through various databases. The quality of 14 studies was assessed by Cochrane risk bias (5 randomized controlled trials- RCT) and Newcastle-Ottawa scale (9 uncontrolled studies).
The positive effects on motor (5 studies) and non-motor symptoms (4 studies) described in uncontrolled studies have not been confirmed by the few and small RCTs. Only one RCT found a reduction of levodopa-induced dyskinesias, another a reduction in anxiety and tremor amplitude in an anxiogenic situation, while the remaining three without effect on motor/non-motor symptoms. Physical and psychological symptoms are among the most common side effects.
There is insufficient evidence to reform international legislation regarding cannabis use in PD practice.
2019, Progress in Neuro-Psychopharmacology and Biological Psychiatry
Increased incidence of obesity and excess weight lead to an increased incidence of non-alcoholic fatty liver disease (NAFLD). Recent evidence indicates a protective effect of cannabis consumption on weight gain and related metabolic alterations in psychosis patients. Overall, patients are at greater risk of presenting fatty diseases, such as NAFLD, partly due to lipid and glycemic metabolic disturbances. However, there are no previous studies on the likely effect of cannabis on liver steatosis. We aimed to explore if cannabis consumption had an effect on hepatic steatosis, in a sample of first-episode (FEP) non-affective psychosis.
A total of 390 patients were evaluated at baseline and after 3 years of initiating the antipsychotic treatment. Anthropometric measurements and liver, lipid, and glycemic parameters were obtained at both time points. All but 6.7% of patients were drug-naïve at entry, and they self-reported their cannabis use at both time points. Liver steatosis and fibrosis were evaluated through validated clinical scores (Fatty Liver Index [FLI], Fibrosis-4 [FIB-4], and NAFLD).
At 3-year follow-up, cannabis users presented significantly lower FLI scores than non-users (F = 13.874; p < .001). Moreover, cannabis users less frequently met the criteria for liver steatosis than non-users (X2 = 7.97, p = .019). Longitudinally, patients maintaining cannabis consumption after 3 years presented the smallest increment in FLI over time, which was significantly smaller than the increment in FLI presented by discontinuers (p = .022) and never-users (p = .016). No differences were seen in fibrosis scores associated with cannabis.
Cannabis consumption may produce a protective effect against liver steatosis in psychosis, probably through the modulation of antipsychotic-induced weight gain.
While 4%–5% may appear to represent only a small number of individuals, based on U.S. Census Bureau estimates, 4.5% of those who were 30 years of age during 2008–2016 is estimated to be approximately 1.7 million individuals (U.S. Census Bureau, 2004, 2014). As noted previously, those who use marijuana frequently are at increased risk for addiction, cognitive impairment, and other health concerns (Becker et al., 2014; Gordon et al., 2013; Volkow et al., 2014; Whitlow et al., 2004; Hézode et al., 2008; Ishida et al., 2008), and the highest health risks are associated with chronic use that extends into age 30 and beyond (Auer et al., 2015; Epstein et al., 2015; Terry-McElrath et al., 2017). Results from the current study indicate that the number of individuals at high risk for such negative health outcomes due to frequent marijuana use at age 30 has increased markedly among recent cohorts.
This study examines the extent to which the developmental pattern of frequent marijuana use prevalence from ages 18 to 30 (overall and by gender) has varied across historical time (cohort groups) using data from a national sample of US young adults.
Self-reported data on frequent marijuana use (use on 20+ occasions in the past 30 days) from modal ages 18 to 30 were obtained from 58,059 individuals from 29 sequential cohorts (graduating high school classes of 1976–2004) participating in the Monitoring the Future study. Time-varying effect modeling was used to model cohort group differences in developmental patterns of frequent use overall and by gender.
Developmental patterns of frequent marijuana use prevalence varied meaningfully across cohort groups. Frequent use at age 18 differed significantly across cohort groups as expected based on national data. Among earlier cohort groups (reaching age 30 during 1987–2008), developmental patterns converged by age 30 to relatively low frequent marijuana use prevalence. In contrast, among cohort groups reaching age 30 during 2008–2016, frequent marijuana use at age 30 was significantly higher than all previous cohort groups. Observed cohort differences did not vary significantly by gender.
Cross-cohort convergence in developmental patterns of frequent marijuana use prevalence by age 30 was not observed among recent cohort groups, among whom age 30 frequent marijuana use prevalence was at the highest levels observed since the study began. Higher frequent marijuana use prevalence in late young adulthood has meaningful health risk and service provision implications.
El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario.
The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.
