Cannabis use and reduced risk of elevated fatty liver index in HIV-HCV co-infected patients: a longitudinal analysis (ANRS CO13 HEPAVIH)

ABSTRACT

Background: Cannabis use and elevated fatty liver index (FLI≥ 60) (a biomarker of hepatic steatosis in the general population) have been identified as predictors of HCV-related and overall mortality, respectively, in HIV-HCV co-infected patients. However, the relationship between cannabis use and the risk of elevated FLI has never been explored.

Methods: Using five-year follow-up data from 997 HIV-HCV co-infected patients (ANRS CO13 HEPAVIH cohort), we analyzed the relationship between cannabis use and FLI using mixed-effects multivariable logistic (outcome: elevated FLI yes/no) and linear (outcome: continuous FLI) regression models.

Results: At the last follow-up visit, 27.4% of patients reported regular or daily cannabis use and 27.8% had elevated FLI. After multivariable adjustment, regular or daily cannabis use was associated with a 55% lower risk of elevated FLI (adjusted odds ratio [95% confidence interval]: 0.45 [0.22; 0.94]; p = 0.033) and lower FLI values (adjusted model coefficient: −4.24 [−6.57; −1.91], p < 0.0001).

Conclusions: Cannabis use is associated with a reduced risk of elevated fatty liver index in HIV-HCV co-infected patients. Further research is needed to confirm whether and how cannabinoids may inhibit the development of hepatic steatosis or other metabolic disorders in high-risk populations.

KEYWORDS:

• Cannabis
• hepatitis C
• chronic
• human immunodeficiency virus
• fatty liver
• metabolic diseases

Acknowledgments

This study was sponsored and funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS). The authors thank all members of the ANRS-CO-13-HEPAVIH study group. They especially thank all the physicians and nurses involved in the follow-up of the cohort and all patients who took part in this study. The authors thank Jude Sweeney for the English revision and editing of the manuscript.

The ANRS CO13 HEPAVIH Study Group

Representative of the ANRS CO13 HEPAVIH Study Group: D. Salmon-Ceron.

Scientific Committee: D. Salmon-Ceron (co-Principal investigator), L. Wittkop (co-Principal Investigator & Methodologist), P. Sogni (co-Principal Investigator), L. Esterle (project manager), P. Trimoulet, J. Izopet, L. Serfaty, V. Paradis, B. Spire, P. Carrieri, M.A. Valantin, G. Pialoux, J. Chas, I. Poizot-Martin, K. Barange, A. Naqvi, E. Rosenthal, A. Bicart-See, O. Bouchaud, A. Gervais, C. Lascoux-Combe, C. Goujard, K. Lacombe, C. Duvivier,, D. Neau, P. Morlat, F. Bani-Sadr, L. Meyer, F. Boufassa,, B. Autran, A.M. Roque, C. Solas, H. Fontaine, D. Costagliola, L. Piroth, A. Simon, D. Zucman, F. Boué, P. Miailhes, E. Billaud, H. Aumaître, D. Rey, G. Peytavin, V. Petrov-Sanchez, Axel Levier.

Clinical Centers (ward/participating physicians): APHP, Hôpitaux Universitaires Paris Centre, Paris (Médecine Interne et Maladies Infectieuses: D. Salmon, R. Usubillaga; Hépato-gastro-entérologie: P. Sogni; Anatomo-pathologie: B. Terris; Virologie:P. Tremeaux); APHP Pitié-Salpétrière, Paris (Maladies Infectieuses et Tropicales: C. Katlama, M.A. Valantin, H. Stitou; Médecine Interne: A. Simon, P. Cacoub, S. Nafissa; Hépato-gastro-entérologie: Y. Benhamou; Anatomo-pathologie: F. Charlotte; Virologie: S. Fourati); APHM Sainte-Marguerite, Marseille (Service d’Immuno-Hématologie Clinique: I. Poizot-Martin, O. Zaegel, H. Laroche; Virologie: C. Tamalet); APHP Tenon, Paris (Maladies Infectieuses et Tropicales: G. Pialoux, J. Chas; Anatomo-pathologie: P. Callard, F. Bendjaballah; Virologie: C. Amiel, C. Le Pendeven); CHU Purpan, Toulouse (Maladies Infectieuses et Tropicales: B. Marchou; Médecine interne: L. Alric; Hépato-gastro-entérologie: K. Barange, S. Metivier; Anatomo-pathologie: J. Selves; Virologie: F. Larroquette); CHU Archet, Nice (Médecine Interne: E. Rosenthal; Infectiologie: A. Naqvi, V. Rio; Anatomo-pathologie: J. Haudebourg, M.C. Saint-Paul; Virologie: A. De Monte, V. Giordanengo, C. Partouche); APHP Avicenne, Bobigny (Médecine Interne – Unité VIH: O. Bouchaud; Anatomo-pathologie: A. Martin, M. Ziol; Virologie: Y. Baazia, V. Iwaka-Bande, A. Gerber); Hôpital Joseph Ducuing, Toulouse (Médecine Interne: M. Uzan, A. Bicart-See, D. Garipuy, M.J. Ferro-Collados; Anatomo-pathologie: J. Selves; Virologie: F. Nicot); APHP Bichat – Claude-Bernard, Paris (Maladies Infectieuses:, A. Gervais, Y. Yazdanpanah; Anatomo-pathologie: H. Adle-Biassette; Virologie: G. Alexandre, Pharmacologie: G. Peytavin); APHP Saint-Louis, Paris (Maladies infectieuses: C. Lascoux-Combe, J.M. Molina; Anatomo-pathologie: P. Bertheau; Virologie:M.L. Chaix, C. Delaugerre, S. Maylin); APHP Saint-Antoine (Maladies Infectieuses et Tropicales: K. Lacombe, J. Bottero; J. Krause, P.M. Girard, Anatomo-pathologie: D. Wendum, P. Cervera, J. Adam; Virologie: C. Viala); APHP, Hôpitaux Paris Sud, Bicêtre, Paris (Maladies Infectieuses et Tropicales: D. Vittecocq; Médecine Interne: C. Goujard, Y. Quertainmont, E. Teicher; Virologie: C. Pallier); APHP Necker, Paris (Maladies Infectieuses et Tropicales: O. Lortholary, C. Duvivier, C. Rouzaud, J. Lourenco, F. Touam, C. Louisin: Virologie: V. Avettand-Fenoel, E. Gardiennet, A. Mélard); CHU Bordeaux Hôpital Pellegrin, Bordeaux (Maladies Infectieuses et Tropicales: D. Neau, A. Ochoa, E. Blanchard, S. Castet-Lafarie, C. Cazanave, D. Malvy, M. Dupon, H. Dutronc, F. Dauchy, L. Lacaze-Buzy, A. Desclaux; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas); CHU Bordeaux Hôpital Saint-André, Bordeaux (Médecine Interne et Maladies Infectieuses: P. Morlat, D. Lacoste, F. Bonnet, N. Bernard, M. Hessamfar, J, F. Paccalin, C. Martell, M. C. Pertusa, M. Vandenhende, P. Mercié, D. Malvy, T. Pistone, M.C. Receveur, M. Méchain, P. Duffau, C Rivoisy, I. Faure, S. Caldato; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas, P. Bellecave, C. Tumiotto); CHU Bordeaux Hôpital du Haut-Levêque, Bordeaux (Médecine Interne: J.L. Pellegrin, J.F. Viallard, E. Lazzaro, C. Greib; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas); Hôpital FOCH, Suresnes (Médecine Interne: D. Zucman, C. Majerholc; Virologie: M. Brollo, E. Farfour); APHP Antoine Béclère, Clamart (Médecine Interne: F. Boué, J. Polo Devoto, I. Kansau, V. Chambrin, C. Pignon, L. Berroukeche, R. Fior, V. Martinez, S. Abgrall, M. Favier; Virologie: C. Deback); CHU Henri Mondor, Créteil (Immunologie Clinique: Y. Lévy, S. Dominguez, J.D. Lelièvre, A.S. Lascaux, G. Melica); CHU Nantes Hôpital Hôtel Dieu, Nantes (Maladies Infectieuses et Tropicales: E. Billaud, F. Raffi, C. Allavena, V. Reliquet, D. Boutoille, C. Biron; M. Lefebvre, N. Hall, S. Bouchez; Virologie: A. Rodallec, L. Le Guen, C. Hemon); Hôpital de la Croix Rousse, Lyon (Maladies Infectieuses et Tropicales: P. Miailhes, D. Peyramond, C. Chidiac, F. Ader, F. Biron, A. Boibieux, L. Cotte, T. Ferry, T. Perpoint, J. Koffi, F. Zoulim, F. Bailly, P. Lack, M. Maynard, S. Radenne, M. Amiri, F Valour; Hépato-gastro-entérologie: J. Koffi, F. Zoulim, F. Bailly, P. Lack, M. Maynard, S. Radenne, C. Augustin-Normand; Virologie: C. Scholtes, T.T. Le-Thi); CHU Dijon, Dijon (Département d’infectiologie: L. Piroth, P. Chavanet M. Duong Van Huyen, M. Buisson, A. Waldner-Combernoux, S. Mahy, A. Salmon Rousseau, C. Martins); CH Perpignan, Perpignan (Maladies infectieuses et tropicales: H. Aumaître, Virologie: S. Galim); CHU Robert Debré, Reims (Médecine interne, maladies infectieuses et immunologie clinique: F. Bani-Sadr, D. Lambert, Y Nguyen, J.L. Berger, M. Hentzien, Virologie: V. Brodard); CHRU Strasbourg (Le Trait d’Union: D Rey, M Partisani, ML Batard, C Cheneau, M Priester, C Bernard-Henry, E de Mautort, P.Fischer, Virologie: P Gantner et S Fafi-Kremer)

Data collection: F. Roustant, P. Platterier, I. Kmiec, L. Traore, S. Lepuil, S. Parlier, V. Sicart-Payssan, E. Bedel, S. Anriamiandrisoa, C. Pomes, F. Touam, C. Louisin, M. Mole, C. Bolliot, P Catalan, M. Mebarki, A. Adda-Lievin, P. Thilbaut, Y. Ousidhoum, F.Z. Makhoukhi, O. Braik, R. Bayoud, C. Gatey, M.P. Pietri, V. Le Baut, R. Ben Rayana, D. Bornarel, C. Chesnel, D. Beniken, M. Pauchard, S. Akel, S. Caldato, C. Lions, A. Ivanova, A-S. Ritleg, C. Debreux, L. Chalal, J.Zelie, H. Hue, A. Soria, M. Cavellec, S. Breau, A. Joulie, P. Fisher, S. Gohier, D. Croisier-Bertin, S. Ogoudjobi, C. Brochier, V. Thoirain-Galvan, M. Le Cam.

Management, statistical analyses: P. Carrieri, M. Chalouni, V. Conte, L. Dequae-Merchadou, M. Desvallees, L. Esterle, C. Gilbert, S. Gillet, R. Knight, T. Lemboub, F. Marcellin, L. Michel, M. Mora, C. Protopopescu, P. Roux, B. Spire, S. Tezkratt, T. Barré, T. Rojas Rojas, M. Baudoin, M. Santos V. Di Beo, M.Nishimwe, L Wittkop.

Declaration of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was sponsored and funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS).