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marijuana and hep c

Is Marijuana Effective for Treating the Side Effects of Hepatitis C Medication?

Hepatitis C (HCV) is a widespread virus that can lead to chronic liver problems. Some people are turning to marijuana, or cannabis, to manage the unpleasant side effects associated with HCV and HCV medications.

Is this treatment right for you? Learn more about the benefits and risks of cannabis use.

Hepatitis C is a viral infection that attacks the liver. It’s transmitted through infected blood, often through sharing needles during drug use. It can also be transmitted through:

  • tattoo needles
  • the birthing process (from an infected mother to their baby)
  • blood transfusions
  • sexual contact (rarely)

People infected with HCV may have no symptoms for months, years, or even decades. The condition is typically diagnosed when liver symptoms lead to complications and medical testing.

The National Organization for the Reform of Marijuana Laws, a group that works to reform marijuana laws, explains that many people with HCV use cannabis to ease their general symptoms from the virus. Cannabis is also used to ease the nausea associated with other HCV treatments. This practice is relatively popular, but research results have been mixed. It’s unclear if marijuana is helpful overall and if there are any overall risks.

Marijuana alone doesn’t treat an HCV infection, and it doesn’t treat the complications that lead to liver disease and cirrhosis. Instead, the drug may be particularly effective at reducing nausea associated with the medications used to treat the virus. Marijuana can be:

  • inhaled by smoking
  • ingested by taking cannabis pills or edibles
  • absorbed under the tongue as a tincture
  • vaporized

A few studies have credited marijuana use with stricter adherence to treatment protocols. These studies have presented the idea that reducing the unpleasant side effects makes the antiviral medications more tolerable. This way, more people will finish the full course. In turn, people experience better outcomes.

Research on this topic has mixed outcomes. The Canadian Journal of Gastroenterology & Hepatology reports that marijuana use among people infected with HCV is prevalent. The study also showed that people who included the drug in their overall treatment plan didn’t necessarily stick to the plan more closely than their counterparts who didn’t take the drug.

Using marijuana didn’t influence liver biopsies or impact the “hard outcomes” of the antiviral treatment. At the same time, taking the drug didn’t necessarily hurt anything. The study didn’t find any evidence that smoking or taking cannabis pills does any additional damage to the liver, despite what previous research had suggested.

Marijuana isn’t legal in all states. This is the case even when it’s used for medical management of HCV. What’s the good news? Advances in the field are improving medications and lessening treatment durations.

Antiviral medications are usually a first line of defense against HCV. Traditional courses of medication take 24 to 72 weeks. This therapy can give you flu-like symptoms, anemia, or neutropenia. New combinations of antiviral medications may shorten treatment duration to just 12 weeks. It also significantly lessens the most uncomfortable side effects.

If you experience nausea in response to your medication, your doctor can prescribe anti-nausea drugs. These can include:

  • Zofran
  • Compazine
  • Phenergan
  • Trilafon
  • Torecan

If your nausea keeps you from taking pills, you can find some that are available as suppositories.

You may also be able to control your nausea through dietary and lifestyle changes:

  • Keep a food diary to track any triggers.
  • Eat small, frequent meals.
  • If your nausea is worse in the morning, try keeping some food next to your bed and getting up more slowly.

As with most other drugs or treatments, there are certain risks with the use of cannabis. Marijuana may cause dizziness. It can also increase your risk of bleeding, affect your blood sugar levels, and lower your blood pressure.

Marijuana can also affect your liver. Whether or not marijuana makes HCV liver disease worse is still up for debate.

Clinical Infectious Diseases published a study in 2013 about the connection between cannabis use and worsening liver symptoms from HCV. In the group of nearly 700 people, the median use of marijuana was seven joints per day. In the end, this study found no significant link between marijuana smoking and liver fibrosis. For every 10 additional joints a person smoked per week over the median, their chance of being diagnosed with cirrhosis increased only slightly.

A 2006 study published in the European Journal of Gastroenterology & Hepatology shares that people with HCV who use marijuana adhere more closely to their treatment protocols. Their conclusion is that any “potential benefits of a higher likelihood of treatment success appear to outweigh risks.”

Still, not all researchers agree. More work needs to be done in this area to assess the benefits and risks further.

Antiviral medications used to treat hepatitis C virus (HCV) can cause some unpleasant symptoms. Medicinal marijuana may be able to curb these side effects.

Can Pot Prevent Fatty Liver Disease in Those With Hep C and HIV?

A recent study found that daily cannabis use was associated with a reduced risk of the liver condition in this population.

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Among people living with HIV and hepatitis C virus (HCV), fatty liver disease, also known as steatosis, is a serious health concern. Hep C is a liver-based virus that raises the risk of steatosis, and coinfection with HIV is known to exacerbate liver-related health problems in those living with HCV.

A French research team has published a study in the Journal of Viral Hepatology that found that regular pot use is associated with a lower risk of fatty liver disease among those with HIV and HCV, even when the investigators controlled for body weight and other major risk factors for the liver condition.

So does this mean everyone with HIV and HCV should fire up the bong or bake a bunch of brownies? Like any prudent scientist, the new study’s research director, Patrizia Carrieri, PhD, a researcher at the French National Institute of Health and Medical Research (INSERM) who is based in Marseille, says the results of her study should be interpreted with caution. Much more research is needed to determine whether there is in fact a causal relationship between using pot and a mitigated risk of fatty liver.

Carrieri’s paper also stresses that addressing lifestyle factors such as diet, exercise and alcohol consumption are vitally important when it comes to modulating the risk of fatty liver among HIV/HCV-positive individuals.

Then there is the often-overlooked fact that cosuming pot is, in fact, a form of smoking (provided, of course, that individuals consume it through lighting up). “Smoking, whatever the product,” Carrieri notes, “is not good for your health. This is particularly true for people living with HIV and HCV.”

An estimated 40 to 67 percent of those living with HIV and HCV have fatty liver disease. The accumulation of fat in liver cells is a potential risk factor for the progression of fibrosis (scarring) of the organ and for liver cancer and may lessen the chance of successfully curing hep C with direct-acting antiviral treatment.

Risk factors for fatty liver particular to those coinfected with HIV and HCV include antiretroviral (ARV) treatment for HIV, especially nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Research has indicated that this class of HIV medications is associated with metabolic disorders, including fatty liver. Additionally, alcohol abuse is common in the HIV/HCV-positive population.

Hep C is also associated with a higher risk of insulin resistance and type 2 diabetes. Researchers have firmly established that insulin resistance plays a key role in the development of fatty liver disease.

As for pot’s role as a potential mitigating risk factor for fatty liver, a study published in Clinical Infectious Diseases in 2015 found that those with HIV and HCV who used cannabis had a lower risk of developing insulin resistance and steatosis.

Looking to further explore this association, the French group conducted what is known as a cross-sectional study (meaning data was collected at one specific point rather than over time, providing a snapshot effect) among 838 people with HIV and HCV who were members of ANRS CO13-HEPAVIH, an ongoing study of HIV/HCV-coinfected individuals conducted in various French clinics since 2005.

The participants included in the analysis all had data in their medical records about their cannabis use, or lack thereof, as well as results from an ultrasound examination for steatosis. Forty percent of them had fatty liver disease.

Seventy percent of the participants were men.

The participants were asked whether, during the previous month, they used cannabis “never” (53 percent gave this answer), “sometimes” (21.7 percent), “regularly” (11.7 percent) or “every day” (14 percent).

The study authors adjusted their data to account for various risk factors for fatty liver disease, including body mass index (BMI), current or past exposure to the ARV combination tablet Combivir (zidovudine/lamivudine) and hazardous alcohol consumption. After this adjustment, the investigators found that daily cannabis use, compared with never or sometimes using the substance, was associated with a 36 percent reduced likelihood of having steatosis.

Otherwise, being overweight or obese (having a BMI above 20 and 25, respectively), compared with being underweight (a BMI under 18), was associated with a 93 percent increased risk of fatty liver disease. Any exposure to Combivir, compared with no exposure, was linked to a 51 percent increased risk of the liver condition. And hazardous consumption of alcohol, compared with a lack of hazardous usage, was linked to 73 percent increased risk of steatosis.

The study authors acknowledged that their findings about pot’s link with a reduced steatosis risk stood in contrast to a cross-sectional study, published in the journal Gastroenterology in 2008, that found that daily use of cannabis was actually associated with an increased risk of the liver condition among those with HCV.

“The inconsistency is perhaps due to the difference in the study populations,” says Carrieri. “That study included individuals living with HCV only, who did not use drugs other than cannabis and who were never treated for HCV. Our study group was coinfected with HIV, and we did not exclude individuals who used drugs or those who had been treated, whether cured or not, for HCV.”

Carrieri and her colleagues’ new paper is limited by its cross-sectional design. Because they did not follow the study cohort over time, they could not analyze how cannabis may be associated with the development or evolution of fatty liver disease. Additionally, the study cannot rule out that steatosis led to greater use of cannabis. The study could also not parse its data to determine how short- versus long-term use of pot may be differently associated with steatosis risk.

“It would be interesting,” Carrieri says, “to conduct experimental research, such as randomized trials, to study the effect of specific cannabinoids contained in cannabis on specific medical conditions, including steatosis, diabetes and obesity.”

A recent study found that daily cannabis use was associated with a reduced risk of the liver condition in this population.