Promising studies with Hep C and Cannabis

[Sequoiacrone]

Cannabis use improves retention and virological
outcomes in patients treated for hepatitis C

Eur J Gastroenterol Hepatol Oct 2006 18:1057-1063
Diana L. Sylvestrea,b, Barry J. Clementsb and Yvonne Malibub
aDepartment of Medicine, University of California, San Francisco, California, USA
and bOrganization to Achieve Solutions in Substance-Abuse (OASIS), Oakland, California, USA

Note from Jules Levin: this study was first presented at a conference 2 years ago or longer.

"...The results of this observational study suggest that the use of cannabis during HCV treatment can improve adherence by increasing the duration of time that patients remain on therapy; this translates to reduced rates of post-treatment virological relapse and improved SVR....."

As shown in Fig. 3, cannabis users were no more likely than non-users to take at least 80% of the prescribed interferon, 91 versus 76% (P=0.2), nor were they more likely to take at least 80% of the prescribed ribavirin, 91 versus 84% (P>0.5). However, cannabis users were significantly more likely than non-users to remain on HCV treatment for at least 80% of the projected treatment course, 95 versus 67% (P=0.01). The average duration of HCV treatment in cannabis users was 38 weeks compared with 33 weeks for the non-users.

for the rest of this article:
http://www.natap.org/2006/HCV/091506_02.htm

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Moderate Cannabis Use Associated with Improved Treatment Response in Hepatitis C Patients on Methadone
By Liz Highleyman

Interferon-based therapy (http://www.hivandhepatitis.com/hep_c/hepc_news_inter.html) for chronic hepatitis C virus (HCV) infection (http://www.hivandhepatitis.com/hep_c.html) is often limited by side effects (http://www.hivandhepatitis.com/hep_c/hepc_news.html#side) including flu-like symptoms, fatigue, insomnia, loss of appetite, nausea, muscle and joint pain, and depression, which can lead to poor adherence, dose reduction, or treatment discontinuation.

http://www.hivandhepatitis.com/images2006/cannabis_300a.jpg
Medicinal cannabis may relieve such side effects and help patients stay on treatment, according to a study published in the October 2006 European Journal of Gastroenterology and Hepatology.

Several studies - as well as ample anecdotal evidence - have demonstrated that medical marijuana can reduce nausea, increase appetite, and improve wasting in people with HIV (http://www.hivandhepatitis.com/hiv_aids.html).

Diana Sylvestre, MD, of the University of California at San Francisco and colleagues conducted a study to define the impact of cannabis use during HCV treatment. The prospective observational study included 71 patients at OASIS (Organization to Achieve Solutions in Substance Abuse), a community-based clinic providing medical and psychiatric treatment to substance users in Oakland, California.

Conclusion

In conclusion, the authors wrote, "Our results suggest that modest cannabis use may offer symptomatic and virological benefit to some patients undergoing HCV treatment by helping them maintain adherence to the challenging medication regimen."

Discussion

In their discussion, the authors wrote that their results "suggest that the use of cannabis during HCV treatment can improve adherence by increasing the duration of time that patients remain on therapy; this translates to reduced rates of post-treatment virological relapse and improved SVR."
"Although other potential mechanisms may contribute to its enhancement of treatment outcomes, such as altered immunological function and improved nutritional status," they added, "it appears that the moderate use of cannabis during HCV treatment does not lead to deleterious consequences."
In this study, it appears that the treatment response benefit was primarily due to improved ability to stay on adequate doses of interferon and/or ribavirin. Sylvestre told HIV and Hepatitis.com that the researchers could not judge whether there was a direct antiviral effect. "It was probably more of a side-effect management effect than an antiviral effect, but we can't rule out the latter," she said.

To see the entire article:
http://www.hivandhepatitis.com/hep_c/news/2006/091506_a.html

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Hepatitis C - The Silent Killer
Can Medical Cannabis Help?

Jay R. Cavanaugh, PhD

Can medical cannabis help?
The short answer is yes. The primary role of cannabis is to stimulate appetite, reduce nausea and vomiting, and treat joint pain. This role is applicable to HCV patients undergoing chemotherapy, those with cancer or cirrhosis, and those with joint pain and headache. Cannabis is far less toxic than other medications that might be prescribed for these conditions and where liver impairment is concerned, it is vital to avoid toxicity. Cannabis may help alleviate the depression often produced by chronic illness and by combination drug therapy. Additionally, cannabis based food products may provide needed extra nutrition without taxing the liver. Using cannabis in place of alcohol is an established harm reduction technique particularly important when liver disease is present.
Perhaps more important but still unknown is the possibility that some of the chemical components of cannabis (the Cannabinoids) may actually reduce liver inflammation and slow the progression of both cirrhosis and Hepatocellular carcinoma. The cannabinoids have been shown to be powerful anti-inflammatories and anti-oxidants. They have also been shown to have anti-neoplastic activity, at least in gliomas (a form of brain cancer). Cannabinoids both slow programmed cell death (apoptosis) in normal cells while accelerating apoptosis in cancer cells.

for the entire article link:
http://www.pacifier.com/~alive/cmu/hepatitis_c.htm

[Sequoiacrone]

Is marijuana an effective treatment for the symptoms of hepatitis C? General Reference (not clearly pro or con)
The US National Institute of Health stated on its website (accessed Sep. 29, 2006):
Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus (HCV).[...] There are approximately 4 million people in the United States who are infected with hepatitis C (about 1 in 70 to 100 people). Other hepatitis virus infections include hepatitis A and hepatitis B. Each viral hepatitis infection is caused by a different virus.
Many people who are infected with the hepatitis C do not have symptoms. Hepatitis C is often detected during blood tests for a routine physical or other medical procedure. If the infection has been present for many years, the liver may be permanently scarred -- a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.
The following symptoms could occur with hepatitis C infection: Jaundice, Abdominal pain (right upper abdomen), Fatigue, Loss of appetite, Nausea, Vomiting, Low-grade fever, Pale or clay-colored stools, Dark urine, Generalized itching, Ascites, Bleeding varices (dilated veins in the esophagus).


Sep. 29, 2006 - National Institutes of Health (NIH)http://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=571)
PRO (yes)Diana L. Sylvestre, MD, Assistant Clinical Professor in the Department of Medicine at the University of California, San Francisco, et al. stated in the Oct. 2006 article "Cannabis Use Improves Retention and Virological Outcomes in Patients Treated for Hepatitis C," published in the European Journal of Gastroenterology & Hepatology:
Our results suggest that modest cannabis use may offer symptomatic and virological benefit to some patients undergoing HCV treatment by helping them maintain adherence to the challenging medication regimen.

Oct. 2006 - Diana L. Sylvestre, MD http://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=574)
Benedikt Fischer, PhD, Director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research at the University of Victoria, and Jens Reimer, MD, a Research Psychiatrist at the Center for Interdisciplinary Addiction Research at the University of Hamburg, et al., stated in their Oct. 2006 article "Treatment for Hepatitis C Virus and Cannabis Use in Illicit Drug User Patients: Implications and Questions," published in the European Journal of Gastroenterology & Hepatology:
In fact, there is substantial evidence that cannabis use may help address key challenges faced by drug users in HCV treatment (e.g., nausea, depression), especially when such treatment occurs in the context of methadone maintenance treatment which may amplify these consequences.

While further research is required on the biological and clinical aspects of the benefits of cannabis use for HCV treatment, and the effectiveness of cannabis use for HCV treatment needs to be explored in larger study populations, we advocate that in the interim existing barriers to cannabis use are removed for drug users undergoing HCV treatment until the conclusive empirical basis for evidence-based guidance is available.

Oct. 2006 - Benedikt Fischer, PhD http://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=576)
Jens Reimer, MD http://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=579)
Rick Weiss, a science and medical reporter, discussed the study noted above (by Benedikt Fischer et al.) in his article "Marijuana Aids Therapy," published Sept. 13, 2006 in the Washington Post:
Marijuana can improve the effectiveness of drug therapy for hepatitis C, a potentially deadly viral infection that affects more than 3 million Americans, a study has found. The work adds to a growing literature supporting the notion that in some circumstances pot can offer medical benefits. Treatment for hepatitis C involves months of therapy with two powerful drugs, interferon and ribavirin, that have severe side effects, including extreme fatigue, nausea, muscle aches, loss of appetite and depression. Because of those side effects, many patients do not finish treatment and the virus ends up destroying their livers.
While it is possible that the marijuana had a specific, positive biomedical effect, it is more likely that it helped patients by reducing depression, improving appetite and offering psychological benefits that helped the patients tolerate the treatment's side effects, the team reports in the current issue of the European Journal of Gastroenterology & Hepatology.


Sep. 13, 2006 - Rick Weiss http://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=580)
Dean Edell, MD, a physician and radio show host, stated in a Nov. 30, 2000 article "I'm Getting Treatment For Hepatitis C. Will Marijuana Help Me Or Harm Me?" in response to a letter from an individual with Hepatitis C using marijuana, posted on HealthCentral.com:
People...have used marijuana to fight nausea with no negative consequences and any anti-nausea drug that the doctor gives you will also be metabolized by the liver. I feel more secure with your liver trying to handle marijuana. Marinol, the FDA-approved pill form of marijuana has shown no toxicity to the liver.

I would estimate marijuana to be as safe as anything else. Interferon and ribarvirin is a pretty hefty combination that can be curative in a significant percentage of cases. It's basically all we have for hepatitis C. Interferon can make you pretty sick, but ribarvirin is fairly easy on you. They are both antiviral drugs.

Nov. 30, 2000 - Dean Edell, MD http://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gifhttp://medicalmarijuana.procon.org/images/gstar.gif (http://medicalmarijuana.procon.org/viewsource.asp?ID=584)
To view the con side of the review:
http://medicalmarijuana.procon.org/viewanswers.asp?questionID=217