There is conflicting evidence regarding the impact of cannabis use on liver steatosis in patients affected by HIV and HCV infections. We therefore assessed the relationship between the use of cannabis and hepatic steatosis in a cohort of people living with and without HIV and HCV.
Cross-sectional analysis of the Miami Adult Studies on HIV (MASH) cohort. The use of cannabis in the past 30 days was self-reported. Hepatic steatosis (>5%) was assessed with magnetic resonance-determined proton density fat-fraction (MRI-PDFF).
There were 467 participants of whom 50.3% were HIV-infected on antiretroviral therapy and 26.1% were HCV-infected. Sixty-eight participants (14.6%) had hepatic steatosis. Multivariate logistic regression showed that BMI (kg/m2; adjusted odds ratio [aOR] 1.11, 95% CI 1.06-1.17, P <0.001) and cannabis use (aOR 0.48, 95% CI 0.26-0.91, P=0.024) were significant independent predictors of hepatic steatosis after adjustment for covariates found significant in univariate analyses. Cannabis use reduces the risk of hepatic steatosis in both obese (BMI >30 kg/m2; relative risk [RR] 0.47, 95% CI 0.22-0.98, P=0.044) and non-obese (RR 0.37, CI95% 0.14-0.94, P=0.038). Bivariate logistic regression analysis stratified by HIV/HCV status was used to study the relationship of BMI and cannabis with hepatic steatosis in HIV and/or HCV. The use of cannabis was associated with lower odds for hepatic steatosis in the HIV/HCV-uninfected (odds ratio [OR] 0.18, 95% CI 0.05-0.64, P=0.008) and HIV mono-infected (OR 0.40, 95% CI 0.16-0.99, P=0.047) groups, but not in HCV-infected groups (Table). BMI increased the risk of liver steatosis in all groups except in the HCV mono-infected (Table).
Based on our results, the use of cannabis may reduce the risk of hepatic steatosis in HIV/HCV-uninfected and HIV mono-infected, but not in HCV-infected individuals. The analyses showed this association both in obese and non-obese participants. These findings add to a growing body of evidence that is not entirely consistent on the impact of cannabis use on hepatic steatosis. Studies are needed to elucidate lifestyle and biologic mechanisms for the beneficial effect of cannabis use observed in this study.