In a landmark study of the impact of cannabis smoking on the advancement of liver fibrosis throughout predominantly male hepatitis C/HIV co-infected patients, published in 2013, scientists from McGill University in Canada discovered no link between cannabis use and liver fibrosis progression in hepatitis C. These results were later confirmed by another study of 575 co-infected women who had consumed cannabis, largely made up of lighter users. 
The results were quite frankly surprising, because daily cannabis use had earlier been associated with the progression of liver fibrosis in this population.  Previous studies had revealed that cannabis use throughout people with the hepatitis C virus resulted in increased steatosis and liver fibrosis.   
The liver disease that accompanies the progression of hepatitis C viral infection usually happens in several stages. The first, steatosis, is an accumulation of fat in the liver and is common in hepatitis C. Fibrosis is the replacement of damaged cells with scar tissue, which interferes with the organization and function of the liver. Steatosis can lead to fibrosis, which can then lead to cirrhosis of the liver, the final stage of liver disease in which scarring severely impedes the liver’s function to the point of failure.
Previously, before the emergence of novel pharmaceutical therapies, hepatitis C often led to liver cancer. Today, hepatitis C treatments often result in a cure, though the price of these treatment options can be very high. Even though these treatments exist, hepatitis C-related liver cirrhosis still continues to be the main reason for liver transplants. One study showed that cannabis use may actually have a blunting effect on endocannabinoid signaling response to interferon-alpha treatment for hepatitis C. The impact of this decrease in endocannabinoid serum levels will require future study. 
The very first initial antiviral drugs started to show up in the late 1970s. One of the earliest studies of combination therapy on an emerging hepatitis variant took place in 1986, before the hepatitis C virus had even been identified as the cause. The use of cannabis to combat nausea and vomiting of such antiviral treatments had become more prevalent after the AIDS crisis of the early 1980s, when alternative approaches to deal with pharmaceutical side effects became crucial to compliance with these treatments.
Hepatitis C is treated with a long-term course of pharmaceuticals, occasionally in combination. For a time, cannabis used to lessen the side effects of pharmaceutical treatments for hepatitis C and help with treatment compliance. The use of cannabinoids to mitigate these side effects of these treatments has become increasingly common.
Medical disclaimer: the information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult your doctor. This may include prescribed medications for chronic health conditions, assessing the benefits and drawbacks to treat pain with medical marijuana, and to find appropriate cures or treatments for hepatitis C virus (HCV), and avoiding liver failure by being proactive with lifestyle changes.
A review of the endocannabinoid system’s (ECS) role in liver diseases, beyond viral infection in hepatitis C, noted that it plays an important role in a range of diseases, including “non-alcoholic liver disease, alcoholic liver disease, hepatic encephalopathy, and autoimmune hepatitis [and related conditions], altered hepatic hemodynamics, cirrhotic cardiomyopathy, metabolic syndrome, and ischemia/reperfusion disease.” It concluded by noting that the endocannabinoid system is currently the target of a lot of preclinical studies to create fresh treatments for liver diseases, despite some early failures.  Plant-based cannabinoids such as THCV and CBD, may be of value in blocking the CB1 receptors in the liver. Cannabinoids that activate CB2 receptors, such as beta-caryophyllene and perhaps CBD, may eventually help protect the liver from hepatitis C damage, as it does in animal models of fatty liver conditions.  For more information, read The Endocannabinoid System Explained.
Research also seems to show that a specific genetic variation in the CB2 receptor is linked to more severe liver inflammation and damage among HCV patients. Because of the serious prognosis of HCV infection and the availability of effective antivirals, cannabis cannot be recommended as the sole treatment, unless other options are unavailable. In those situations, cannabinoids could prove of value. Treatment of symptoms such as nausea and pain are reasonable. Modern antivirals are so effective that adjunctive treatment with cannabinoids is unlikely to add benefit, and should first be discussed with the treating doctor.
Initial research of cannabidiol (CBD) showed that CBD is active against HCV but not against HBV in vitro. CBD inhibited HCV replication by 86.4% in just a single concentrated dose, which suggests that CBD could very well be developed further to be utilized as a therapeutic agent against HCV. In short, CBD showed in vitro activity against viral hepatitis C. 
Animal studies revealed CBD caused an increased level of toxicity in mice , however, there is no recorded liver damage in human CBD users even when they use CBD's highest recommended dosage. Thus far, we understand that CBD's effects on the liver, when taken within the recommended dosages are minimal at worst.
Due to the complexity of endocannabinoid activity in the liver, dosage with cannabinoid medicines becomes more of a balancing act. It is important to use the least amount of THC required to manage any side effects of drug therapy. Alongside this, CB1 antagonists, such as THCV, could be of value in protecting the liver from additional damage, while cannabidiol (CBD) and the terpene beta-caryophyllene may help reduce inflammation; although these approaches remain currently unproven in human subjects. Up to 12.5 mg of oral THC can be utilized to help alleviate nausea and vomiting during cycles of combination therapy. Read our Ultimate Guide to Terpenes.
For nausea and vomiting, oral cannabinoid medicines provide the longest sustained relief. Vaporization and smoking can create faster relief that is easily dosed with little experience.
Just about any strain of cannabis can be used for nausea or vomiting associated with drug therapy, given the doctor in charge of the treatment has researched any potential drug interactions. High-potency THC-dominant strains such as Gorilla Glue #4, Cookies, and OG Kush, are popular with patients, but lower potency strains will work as well and make dosing easier.
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