Journal
CLINICAL INFECTIOUS DISEASES
Volume 63, Issue 4, Pages 512-518Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciw350
Keywords
liver fibrosis; marijuana; HIV; HCV; women
Categories
Funding
- National Institute of Allergy and Infectious Diseases (NIAID) [U01-AI-103401, U01-AI-103408, UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, U01-AI-103397, U01-AI-103390, UO1-AI-34989, UO1-AI-42590]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Cancer Institute (NCI)
- National Institute on Drug Abuse (NIDA)
- National Institute of Mental Health (NIMH)
- National Institute of Dental and Craniofacial Research (NIDCR)
- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- National Institute on Deafness and Other Communication Disorders (NIDCD)
- NIH Office of Research on Women's Health
- University of California, San Francisco Clinical and Translational Science Award program (UCSF CTSA) [UL1-TR000004]
- Atlanta CTSA [UL1-TR000454]
- UCSF Liver Center National Institute of Health [P30 DK026743]
- NIAID [R21 AI088351, K24 AI 108516, R01 AI 087176]
- NIAID
- NICHD
- NCI
- NIDA
- NIMH
- NIDCR
- NIAAA
- NIDCD
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Background. Marijuana (hereafter tetrahydrocannabinol [THC]) use has been associated with liver fibrosis progression in retrospective analyses of patients with chronic hepatitis C (HCV). We studied long-term effects of THC on fibrosis progression in women coinfected with human immunodeficiency virus (HIV)/HCV enrolled in the Women's Interagency HIV Study (WIHS). Methods. Liver fibrosis was categorized according to FIB-4 scores as none, moderate, or significant. THC and alcohol use were quantified as average exposure per week. Associations between THC use and progression to significant fibrosis were assessed using Cox proportional hazards regression. Results. Among 575 HIV/HCV-coinfected women followed for a median of 11 (interquartile range, 6-17) years, 324 (56%) reported no THC use, 141 (25%) less than weekly use, 70 (12%) weekly use, and 40 (7%) daily use at WIHS entry. In univariable analysis, entry FIB-4 score (hazard ratio [HR], 2.26 [95% confidence interval {CI}, 1.88-2.73], P < .001), log HCV RNA (HR, 1.19 [95% CI, 1.02-1.38], P = .02), tobacco use (HR, 1.37 [95% CI, 1.02-1.85], P = .04), CD4(+) count (risk per 100-cell increase: HR, 0.90 [95% CI, .86-.95], P < .001), and log HIV RNA (HR, 1.18 [95% CI, 1.05-1.32], P = .005) were associated with progression to significant fibrosis, as was cumulative alcohol use in follow-up (HR, 1.03 [95% CI, 1.02-1.04], P < .001). In multivariable analysis, entry FIB-4, entry CD4(+) count, and cumulative alcohol use remained significant. Cumulative THC use was not associated with fibrosis progression (HR, 1.01 [95% CI, .92-1.10], P = .83). Conclusions. In this large cohort of HIV/HCV-coinfected women, THC was not associated with progression to significant liver fibrosis. Alcohol use was independently associated with liver fibrosis, and may better predict fibrosis progression in HIV/HCV-coinfected women.
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