Cannabis and Hepatitis CJul5
7/5/2010 5:47 PM
New Mexico, Rhode Island and Washington State specifically mention hepatitis C infection as a condition for which marijuana may be recommended, though New Mexico specifies that a hepatitis C patient be undergoing active antiviral treatment.
The hepatitis C virus attacks the cells of the human liver and is usually spread by exposure to the blood of an infected person, though in rare cases, it has also been passed from an infected mother to her newborn or been contracted by sexual contact. The infection is initially asymptomatic in up to 70% of patients. When symptoms do occur, they are usually mild, and may include low-grade fever, nausea or poor appetite, joint and muscle aching and occasionally right upper abdominal pain. An estimated 200 to 300 million people are infected with hepatitis C worldwide, with some 3-4 million cases in the United States. The diagnosis is often made when abnormal liver enzyme levels are found during routine blood testing, or when the disease has progressed and causes cirrhosis of the liver. Chronic hepatitis C can cause loss of appetite and wasting, severe nausea and vomiting, diffuse muscle and joint pain and abdominal pain, neuropathic pain, and jaundice in later stages.
The course of the disease is highly variable. As many as 75% of people infected with the hepatitis C virus never develop any complications and experience no progression of the disease, though they are considered to have chronic hepatitis C. Up to 2/3 of those with chronic hepatitis C will go on to develop some form of chronic liver disease, and up to 20% will develop frank cirrhosis within 20 to 30 years of being infected. Between 1 and 5% will die from the cirrhosis or from liver cancer, which is a complication of hepatitis C infection. Co-infection with HIV can dramatically worsen the progression of hepatitis C. Unlike hepatitis A and B, there is not yet a vaccine against hepatitis C, though work is being done to develop one.
Chronic hepatitis C infection is often treated with a combination of two medications, pegylated interferon and ribavirin. As many as 50% of patients respond fully to this treatment, with smaller numbers experiencing lesser degrees of response. The treatment can cause significant side effects, however, including muscle and joint pain, loss of appetite and weight loss, nausea and vomiting, fatigue and headaches. Additional prescription medications are often used to treat the side effects of the primary treatment, though, as in other conditions, cannabis has also been used successfully to treat the pain, nausea and loss of appetite that can accompany both the infection itself and its treatment.
A 2006 study at the University of California at San Francisco showed that patients undergoing treatment for hepatitis C were much more likely to complete at least 80% of their treatments if they used cannabis to control the side effects, while side effects limited other patients to completing only about 60% of their treatments. A 2003 study published in the journal Molecular Pharmacology showed that the powerful anti-inflammatory effect of cannabinoids so significantly reduced the inflammation caused by the virus that the fibrotic changes typical of hepatitis C infection might be prevented or reduced, and, in a 2006 article in the European Journal of Gastroenterology and Hepatology, German and Canadian researchers concluded that “…the potential benefits of a higher likelihood of treatment success appear to outweigh the risks…”
However, other studies, including a 2008 study conducted at the University of California at San Francisco, have suggested that stimulation of the CB1 receptors by cannabis might result in an increased risk of liver fibrosis and deposition of fat in the liver in chronic hepatitis C, suggesting--as is so often the case--that more research is needed to understand more fully the effects of cannabis in hepatitis C.