Hepatitis C and Liver Disease

The term “hepatitis” refers to inflammation of the liver. Hepatitis C specifically refers to an infection with the hepatitis C virus (HCV), a contagious infection that may either be a mild illness, lasting a few weeks, or serious, causing lifelong illness that attacks the liver. HCV is spread primarily through contact with the blood of an infected person and can be acute or chronic. Symptoms include nausea, vomiting, abdominal pain, weight loss, fatigue, joint pain and poor appetite. Approximately 75%–85% of people who become infected with hepatitis C virus develop chronic infection. Chronic hepatitis C can progress to cirrhosis (severe scarring of the liver) or liver cancer. An estimated 3.5 million people in the United States have chronic hepatitis C virus infection.

Conventional treatment of chronic hepatitis C consists of antiviral medications. Over recent years, new antiviral medications have become available with 80-100% cure rates depending on the strain of virus being treated. These medications are reported to have fewer side effects than their predecessors, although fatigue, depression, gastrointestinal upset, insomnia and joint pain may occur.

There are a number of scientific reports on the use of cannabis in patients with hepatitis C:

• Three studies found that patients with hepatitis C who used THC-rich cannabis daily (versus non-daily use) were at significantly higher risk of moderate to severe liver fibrosis.^1,2,3
• A more recent study from 2013 reported no link between cannabis use and progression of liver fibrosis in hepatitis C patients who were also HIV positive. The authors of this study reported that previous cross-sectional studies reporting an association between marijuana smoking and liver fibrosis may be biased by reverse causation as patients use more marijuana to relieve symptoms as liver disease progresses.⁴
• Hepatitis C patients who used cannabis who were on anti-viral medication to treat the disease were more likely to stay on treatment than patients who didn’t use cannabis.⁵
• In a mouse model of hepatic encephalopathy (defined as a decline in brain function due to severe liver disease), CBD improved cognition and locomotion due to its anti-inflammatory effects and activation of the 5-HT_1A receptor.⁶
• CBD restored liver function and improved cognition and neurological function in mice with liver failure and hepatic encephalopathy.⁷
• CBD significantly reduced liver inflammation in a mouse model of ischemia-reperfusion, the cutting off blood flow then restoring it as is often seen in liver surgery or liver transplantation.⁸
• CBD protected mouse liver from acute alcohol-induced steatosis (the infiltration of liver cells with fat).⁹

Patients with hepatitis C infection may be reluctant to take conventional medications for other medical conditions, as they are concerned about further damage to the liver. For instance, patients with hepatitis who also have chronic pain conditions are often warned to avoid medications that contain acetaminophen (the active ingredient in Tylenol which is also combined with an opiate such as hydrocodone) because acetaminophen is a leading cause of acute liver failure, even at doses that are within the recommended range. Cannabis, especially CBD-rich chemovars, allows these patients to treat their pain without further liver damage.

I recommend that patients with liver disease who want to use cannabis treatment to use CBD-rich cannabis, and to include beta-caryophyllene,¹⁰ as both have proven anti-inflammatory and liver protective effects. Limiting THC-rich cannabis to intermittent and low doses is the best approach in these patients.

Sources

[←1]

^{Hézode, Christophe, et al. “Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C.” Hepatology 42.1 (2005): 63-71.}

[←2]

^{Hézode, Christophe, et al. “Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C.” Gastroenterology 134.2 (2008): 432-439.}

[←3]

^{Ishida, Julie H., et al. “Influence of cannabis use on severity of hepatitis C disease.” Clinical gastroenterology and hepatology 6.1 (2008): 69-75.}

[←4]

^{Brunet, Laurence, et al. “Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis.” Clinical infectious diseases 57.5 (2013): 663-670.}

[←5]

^{Sylvestre, Diana L., Barry J. Clements, and Yvonne Malibu. “Cannabis use improves retention and virological outcomes in patients treated for hepatitis C.” European journal of gastroenterology & hepatology 18.10 (2006): 1057-1063.}

[←6]

^{Magen, I., et al. “Cannabidiol ameliorates cognitive and motor impairments in bile‐duct ligated mice via 5‐HT1A receptor activation.” British journal of pharmacology 159.4 (2010): 950-957.}

[←7]

^{Avraham, Y., et al. “Cannabidiol improves brain and liver function in a fulminant hepatic failure‐induced model of hepatic encephalopathy in mice.” British journal of pharmacology 162.7 (2011): 1650-1658.}

[←8]

^{Mukhopadhyay, Partha, et al. “Cannabidiol protects against hepatic ischemia/reperfusion injury by attenuating inflammatory signaling and response, oxidative/nitrative stress, and cell death.” Free Radical Biology and Medicine 50.10 (2011): 1368-1381.}

[←9]

^{Yang, Lili, et al. “Cannabidiol protects liver from binge alcohol-induced steatosis by mechanisms including inhibition of oxidative stress and increase in autophagy.” Free Radical Biology and Medicine 68 (2014): 260-267.}

[←10]

^{Calleja MA, et al. The antioxidant effect of beta-caryophyllene protects rat liver from carbon tetrachloride-induced fibrosis by inhibiting hepatic stellate cell activation. Br J Nutr. (2013) 109(3):394.}