Nordmann S, Vilotitch A, Roux P, Esterle L, Spire B, Marcellin F, Salmon-Ceron D, Dabis F, Chas J, Rey D, Wittkop L, Sogni P, Carrieri P
Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
J Viral Hepat. 2018 Feb;25(2):171-179. doi: 10.1111/jvh.12797. Epub 2017 Nov 20.
Liver steatosis is common in human immunodeficiency virus (HIV)-hepatitis C virus (HCV)-co-infected patients. Some recent studies have found that cannabis use is negatively associated with insulin resistance in the general population and in HIV-HCV-co-infected patients. Given the causal link between insulin resistance and steatosis, we hypothesized that cannabis use has a positive impact on steatosis. Therefore, we aimed to study whether cannabis use in this population was associated with a reduced risk of steatosis, measured by ultrasound examination. ANRS CO13-HEPAVIH is a French nationwide multicentre cohort of HIV-HCV-co-infected patients. Medical and socio-behavioural data from clinical follow-up visits and annual self-administered questionnaires were prospectively collected. A cross-sectional analysis was conducted using data from the first visit where both ultrasound examination data for steatosis (positive or negative diagnosis) and data on cannabis use were available. A logistic regression model was used to evaluate the association between cannabis use and steatosis. Among study sample patients (n = 838), 40.1% had steatosis. Fourteen per cent reported daily cannabis use, 11.7% regular use and 74.7% no use or occasional use ("never or sometimes"). Daily cannabis use was independently associated with a reduced prevalence of steatosis (adjusted odds ratio [95% CI] = 0.64 [0.42;0.99]; P = .046), after adjusting for body mass index, hazardous alcohol consumption and current or lifetime use of lamivudine/zidovudine. Daily cannabis use may be a protective factor against steatosis in HIV-HCV-co-infected patients. These findings confirm the need for a clinical evaluation of cannabis-based pharmacotherapies in this population. Eudract.ema.europa.eu number, DGS050367.
肝脂肪变性在人类免疫缺陷病毒（HIV）与丙型肝炎病毒（HCV）合并感染的患者中很常见。最近的一些研究发现，在普通人群以及HIV-HCV合并感染的患者中，使用大麻与胰岛素抵抗呈负相关。鉴于胰岛素抵抗与脂肪变性之间存在因果联系，我们推测使用大麻对脂肪变性有积极影响。因此，我们旨在研究该人群中使用大麻是否与通过超声检查测得的脂肪变性风险降低有关。ANRS CO13-HEPAVIH是一项法国全国性的HIV-HCV合并感染患者多中心队列研究。前瞻性收集了来自临床随访就诊和年度自我管理问卷的医学和社会行为数据。使用首次就诊时的数据进行横断面分析，该数据既有脂肪变性的超声检查数据（阳性或阴性诊断），也有大麻使用数据。采用逻辑回归模型评估大麻使用与脂肪变性之间的关联。在研究样本患者（n = 838）中，40.1%患有脂肪变性。14%的患者报告每天使用大麻，11.7%的患者经常使用，74.7%的患者不使用或偶尔使用（“从不或有时”）。在调整了体重指数、有害酒精消费以及拉米夫定/齐多夫定的当前或终生使用情况后，每天使用大麻与脂肪变性患病率降低独立相关（调整后的优势比[95%可信区间]=0.64[0.42;0.99]；P = 0.046）。每天使用大麻可能是HIV-HCV合并感染患者脂肪变性的一个保护因素。这些发现证实了对该人群基于大麻的药物疗法进行临床评估的必要性。欧盟临床试验注册号，DGS050367。
