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Cannabis use reduces risk of insulin resistance in people with HIV/HCV co-infection
Michael Carter, 2015-04-02 07:00:00
Cannabis use is associated with a reduced
risk of insulin resistance in people with HIV and hepatitis C virus (HCV)
co-infection, French investigators report in the online edition of Clinical Infectious Diseases. Cannabis
users – irrespective of the frequency of use – were 60% less likely to have
insulin resistance (IR) than non-users.
“This is the first longitudinal study
documenting the relationship between the reduced risk of IR and cannabis in a
population particularly concerned by IR risk,” comment the authors. “The
results found were robust as they were confirmed in 3 sensitivity analyses.”
HCV infection is associated with an
increased risk of insulin resistance and type 2 diabetes. A health concern in
its own right, insulin resistance is also associated with a poorer response to
interferon-based anti-HCV therapies.
Many people with HCV are co-infected with
HIV, which has also been associated with insulin resistance. The reasons for
this could include the inflammatory effects of untreated HIV, lifestyle
factors, and disturbances in the lipid metabolism caused by some antiretroviral
Cannabis use is common among people with
HIV and HCV. Consumption of the drug can increase appetite (and weight gain),
but its use has also been associated with reduced obesity, and may therefore
reduce the risk of insulin resistance.
Little is known about the effect of
cannabis use on the risk of insulin resistance and diabetes. The few studies
that have been conducted showed that use of the drug was associated with lower
fasting insulin, reduced risk of insulin resistance and a lower risk of
Investigators from the French ANRS CO13
HEPAVIH study monitored 703 people with HIV and HCV co-infection for 60 months to see
if cannabis use reduced the risk of insulin resistance.
Participants in the study were evaluated at baseline and
then every twelve months. At each study visit, they completed a questionnaire
concerning the frequency of their use of cannabis in the past four weeks –
never, sometimes, frequently, daily. Data were also gathered on other variables
that have been shown to have an association with insulin resistance, which was
defined as HOMA-IR >2.77.
Most (n = 459) of the participants were men
and the median age was 45 years. At the first study visit, recent cannabis use
was reported by 45% of participants, with 21% saying they used the drug
occasionally, 12% reporting regular use and 13% daily cannabis consumption. The
median HOMA-IR value at baseline was 2.06.
Overall, 46% of participants had at least one
HOMA-IR value above 2.77 during follow-up.
The authors’ first analysis showed that
cannabis consumption at any level was associated with a reduced risk of insulin
resistance. Other factors associated with a decreased risk of insulin
resistance included drinking three or more cups of coffee a day, gender, and detectable
HIV viral load. The older antiretroviral
staduvine (d4T) was the only anti-HIV drug associated with insulin resistance.
Liver cirrhosis increased the risk of insulin resistance by approximately 50%,
and the risk was increased four-fold by obesity.
In multivariate analysis, the
relationship between cannabis use at any level and reduced risk of insulin
resistance (OR = 0.4; 95% CI, 0.2-06) was confirmed after taking into account
gender, HIV viral load, use of stavudine and coffee consumption.
Sensitivity analyses also confirmed the
association between use of cannabis and reduced risk of insulin resistance.
The investigators note that the association
they found between cannabis use, obesity and reduced risk of insulin resistance
is consistent with earlier research in the US and also the findings of
“There are several cannabis-based
pharmacotherapies which do not rely on herbal marijuana and are used for
specific indications (e.g. symptoms relief of multiple sclerosis),” conclude
the authors. “The benefits of these products for patients concerned by
increased risk of insulin resistance and diabetes need to be evaluated in
clinical research and practice.”