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Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis.
Clin Infect Dis. 2013 Sep; 57(5):663-70.CI

Abstract

BACKGROUND

Marijuana smoking is common and believed to relieve many symptoms, but daily use has been associated with liver fibrosis in cross-sectional studies. We aimed to estimate the effect of marijuana smoking on liver disease progression in a Canadian prospective multicenter cohort of human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfected persons.

METHODS

Data were analyzed for 690 HCV polymerase chain reaction positive (PCR-positive) individuals without significant fibrosis or end-stage liver disease (ESLD) at baseline. Time-updated Cox Proportional Hazards models were used to assess the association between the average number of joints smoked/week and progression to significant liver fibrosis (APRI ≥ 1.5), cirrhosis (APRI ≥ 2) or ESLD.

RESULTS

At baseline, 53% had smoked marijuana in the past 6 months, consuming a median of 7 joints/week (IQR, 1-21); 40% smoked daily. There was no evidence that marijuana smoking accelerates progression to significant liver fibrosis (APRI ≥ 1.5) or cirrhosis (APRI ≥ 2; hazard ratio [HR]: 1.02 [0.93-1.12] and 0.99 [0.88-1.12], respectively). Each 10 additional joints/week smoked slightly increased the risk of progression to a clinical diagnosis of cirrhosis and ESLD combined (HR, 1.13 [1.01-1.28]). However, when exposure was lagged to 6-12 months before the diagnosis, marijuana was no longer associated with clinical disease progression (HR, 1.10 [0.95-1.26]).

CONCLUSIONS

In this prospective analysis we found no evidence for an association between marijuana smoking and significant liver fibrosis progression in HIV/HCV coinfection. A slight increase in the hazard of cirrhosis and ESLD with higher intensity of marijuana smoking was attenuated after lagging marijuana exposure, suggesting that reverse causation due to self-medication could explain previous results.

Authors+Show Affiliations

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada, H2X 2P4.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23811492

Citation

Brunet, Laurence, et al. "Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV-hepatitis C Coinfection: a Longitudinal Cohort Analysis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 57, no. 5, 2013, pp. 663-70.
Brunet L, Moodie EE, Rollet K, et al. Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis. Clin Infect Dis. 2013;57(5):663-70.
Brunet, L., Moodie, E. E., Rollet, K., Cooper, C., Walmsley, S., Potter, M., & Klein, M. B. (2013). Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 57(5), 663-70. https://doi.org/10.1093/cid/cit378
Brunet L, et al. Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV-hepatitis C Coinfection: a Longitudinal Cohort Analysis. Clin Infect Dis. 2013;57(5):663-70. PubMed PMID: 23811492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis. AU - Brunet,Laurence, AU - Moodie,Erica E M, AU - Rollet,Kathleen, AU - Cooper,Curtis, AU - Walmsley,Sharon, AU - Potter,Martin, AU - Klein,Marina B, AU - ,, Y1 - 2013/06/28/ PY - 2013/7/2/entrez PY - 2013/7/3/pubmed PY - 2014/3/13/medline KW - HCV KW - HIV KW - cannabis KW - cohort study KW - liver disease SP - 663 EP - 70 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 57 IS - 5 N2 - BACKGROUND: Marijuana smoking is common and believed to relieve many symptoms, but daily use has been associated with liver fibrosis in cross-sectional studies. We aimed to estimate the effect of marijuana smoking on liver disease progression in a Canadian prospective multicenter cohort of human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfected persons. METHODS: Data were analyzed for 690 HCV polymerase chain reaction positive (PCR-positive) individuals without significant fibrosis or end-stage liver disease (ESLD) at baseline. Time-updated Cox Proportional Hazards models were used to assess the association between the average number of joints smoked/week and progression to significant liver fibrosis (APRI ≥ 1.5), cirrhosis (APRI ≥ 2) or ESLD. RESULTS: At baseline, 53% had smoked marijuana in the past 6 months, consuming a median of 7 joints/week (IQR, 1-21); 40% smoked daily. There was no evidence that marijuana smoking accelerates progression to significant liver fibrosis (APRI ≥ 1.5) or cirrhosis (APRI ≥ 2; hazard ratio [HR]: 1.02 [0.93-1.12] and 0.99 [0.88-1.12], respectively). Each 10 additional joints/week smoked slightly increased the risk of progression to a clinical diagnosis of cirrhosis and ESLD combined (HR, 1.13 [1.01-1.28]). However, when exposure was lagged to 6-12 months before the diagnosis, marijuana was no longer associated with clinical disease progression (HR, 1.10 [0.95-1.26]). CONCLUSIONS: In this prospective analysis we found no evidence for an association between marijuana smoking and significant liver fibrosis progression in HIV/HCV coinfection. A slight increase in the hazard of cirrhosis and ESLD with higher intensity of marijuana smoking was attenuated after lagging marijuana exposure, suggesting that reverse causation due to self-medication could explain previous results. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/23811492/Marijuana_smoking_does_not_accelerate_progression_of_liver_disease_in_HIV_hepatitis_C_coinfection:_a_longitudinal_cohort_analysis_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cit378 DB - PRIME DP - Unbound Medicine ER -