Cannabis Use and Reduced Risk of Insulin Resistance in HIV-HCV Infected Patients: A Longitudinal Analysis (ANRS CO13 HEPAVIH)
Cannabis Use and Reduced Risk of Insulin Resistance in HIV-HCV Infected Patients: A Longitudinal Analysis (ANRS CO13 HEPAVIH)
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DOI：
10.1093/cid/civ217
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发表时间：
2015-07-01
影响因子：
11.8
通讯作者：
Dabis, Francois
中科院分区：
文献类型：
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作者：
Carrieri, Maria Patrizia;Serfaty, Lawrence;Dabis, Francois
背景。糖尿病和胰岛素抵抗（IR）在人类免疫缺陷病毒-丙型肝炎病毒（HIV-HCV）合并感染的患者中很常见，这一人群也与大麻使用量增加有关。在一些基于人群的调查中，大麻与IR风险降低有关。在HEPAVIH中，我们确定大麻使用是否与降低IR风险一致相关，HEPAVIH是一项法国全国性的hiv - hcv合并感染患者队列。收集HEPAVIH医疗和社会行为数据（使用年度自我管理问卷）。我们使用了至少1次就诊的患者60个月的随访数据，其中IR（使用胰岛素抵抗的稳态模型评估[HOMA-IR]）和大麻使用进行了评估。采用混合logistic回归模型评价IR风险（HOMA-IR > 2.77）与大麻使用（偶尔、定期、每日）之间的关系。在该研究纳入的703名患者（1287次就诊）中，323名（46%）在至少一次随访中有HOMA-IR bbb2.77, 319名（45%）在第一次可用就诊前的6个月内报告使用大麻。在对已知相关因素/混杂因素进行调整后，大麻使用者（无论频率如何）患HOMA-IR的可能性较低（优势比[95%置信区间]，0.4[0.2 - 0.5]）。以HOMA-IR值作为连续变量和截断值为3.8的两项敏感性分析证实了IR风险降低与大麻使用之间的关联。在hiv - hcv合并感染患者中，大麻使用与较低的IR风险相关。以大麻为基础的药物治疗对关注IR和糖尿病风险增加的患者的益处需要在临床研究和实践中进行评估。
Background. Diabetes and insulin resistance (IR) is common in human immunodeficiency virus-hepatitis C virus (HIV-HCV)-coinfected patients, a population also concerned with elevated cannabis use. Cannabis has been associated with reduced IR risk in some population-based surveys. We determined whether cannabis use was consistently associated with reduced IR risk in HEPAVIH, a French nationwide cohort of HIV-HCV-coinfected patients.Methods. HEPAVIH medical and sociobehavioral data were collected (using annual self-administered questionnaires). We used 60 months of follow-up data for patients with at least 1 medical visit where IR (using homeostatic model assessment of insulin resistance [HOMA-IR]) and cannabis use were assessed. A mixed logistic regression model was used to evaluate the association between IR risk (HOMA-IR > 2.77) and cannabis use (occasional, regular, daily).Results. Among the 703 patients included in the study (1287 visits), 323 (46%) had HOMA-IR > 2.77 for at least 1 follow-up visit and 319 (45%) reported cannabis use in the 6 months before the first available visit. Cannabis users (irrespective of frequency) were less likely to have HOMA-IR > 2.77 (odds ratio [95% confidence interval], 0.4 [.2-.5]) after adjustment for known correlates/confounders. Two sensitivity analyses with HOMA-IR values as a continuous variable and a cutoff value of 3.8 confirmed the association between reduced IR risk and cannabis use.Conclusions. Cannabis use is associated with a lower IR risk in HIV-HCV-coinfected patients. The benefits of cannabis-based pharmacotherapies for patients concerned with increased risk of IR and diabetes need to be evaluated in clinical research and practice.