Regular cannabis use and reduced risk of insulin-resistance: a longitudinal assessment (ANRS HEPAVIH CO-13)

Background: HIV-HCV coinfected patients present a high risk of diabetes and insulin resistance (IR). Previous studies have already highlighted an association between cannabis use and a reduced risk of IR in the general population. We tested whether this association was confirmed in HIV/HCV coinfected patients.
Methods: A longitudinal analysis (60-month follow-up) was conducted on a subset of patients from the HEPAVIH cohort who had at least one measurement of insulin-resistance (using HOMA-IR) at a follow-up visit and data about cannabis use from the HEPAVIH''s yearly self-administered questionnaire. Liver fibrosis was assessed by elastography (FibroScan®) with a standard cut-off of >12.5 kPa defining severe fibrosis. Patients with diabetes were excluded from the analysis. Cut-offs for IR were defined according to their potential to predict progression to cirrhosis (HOMA-IR>2.77) or liver cancer (HOMA-IR>3.8), A mixed logistic regression model was used to evaluate the relationship between the risk of insulin resistance (HOMA-IR >2.77) and regular cannabis use (i.e. daily or several times weekly) after adjustment for other potential correlates such as gender, body mass index (BMI), severe liver fibrosis, CD4 cell count, HIV viral load, HCV clearance at enrolment, and exposure to specific antiretrovirals .
Results: Among the 813 patients included in this analysis (accounting for 1580 visits), 395 (49%) had a HOMA-IR >2.77 at least at one follow-up visit. At enrollment, 229 (27%) reported being regular cannabis users in the previous 6-month period; 553 were men and median[IQR] age was 44.6 [44.2-45.0]. Patients reporting regular cannabis use were less likely to have high HOMA-IR measurements (OR[95%CI]: 0.4 [0.2-0.6]) even after multiple adjustment. Elevated coffee consumption (3 cups or more per day) was also found to be associated with lower levels of HOMA-IR. A sensitivity analysis (HOMA-IR cut-off =3.8) confirmed the association with cannabis (OR[95%CI]: 0.60[0.37-0.98], p=0.039) after adjustment for a similar pattern of predictors.
Conclusions: Consistent with results found in the general population, regular cannabis use seems to protect HIV/HCV coinfected patients against insulin resistance. Clinical trials should be designed to investigate the potential benefits of cannabis-based pharmaceutical products, which are less harmful than cannabis smoking, in reducing insulin resistance.

P. Carrieri1,2,3, L. Serfaty4, A. Vilotitch5,6,7, M. Winnock8, I. Poizot-Martin9, M.-A. Loko8, C. Lions5,6,7, C. Lascoux-Combe10, P. Roux5,6,7, D. Salmon-Ceron11, F. Dabis8, B. Spire5,6,7, ANRS CO-13 HEPAVIH Study Group
1INSERM U912 (SESSTIM), Marseille, France, 2Aix Marseille Université, IRD, UMR-S912, Marseille, France, 3ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France, 4Service d'Hépatologie, Hôpital Saint-Antoine, Inserm U680, Université Pierre-et-Marie-Curie, Paris, France, 5INSERM, UMR912 (SESSTIM), Marseille, France, 6Aix Marseille Université, UMR_S912, IRD, Marseille, France, 7ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur, Marseille, France, 8INSERM, U897 and ISPED, Université Victor Segalen, Bordeaux, France, 9Hôpital Sainte-Marguerite, Unité CISIH Sud Hématologie VIH, Marseille, France, 10Hopital Saint-Louis, Paris, France, 11Service des Maladies Infectieuses et Tropicales, Hôpital Cochin, APHP- Université Paris Descartes, Paris, France