Frequent injection cocaine use increases the risk of renal impairment among hepatitis C and HIV co-infected patients

June 2016

Authors:Rossi C, Cox J, Cooper C, Martel-Laferrière V, Walmsley S, Gill J, Sapir-Pichhadze R, Moodie EE, Klein MB
Journal: AIDS
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Abstract

OBJECTIVE
To examine the association between injection cocaine use, hepatitis C virus (HCV) infection and chronic renal impairment (CRI).

DESIGN
Prospective observational cohort study of HIV-HCV co-infected patients.

METHODS
Data from 1,129 participants in the Canadian Co-Infection Cohort with baseline and follow-up serum creatinine measurements between 2003-2014 were analyzed. Prevalent and incident cohorts were created to examine the association between self-reported past, current, and cumulative cocaine use and chronic HCV with CRI. CRI was defined as an estimated glomerular filtration rate <70 mL/min/1.73m. Multivariate logistic regression was used to calculate odds ratios (ORs) and discrete-time proportional hazards models were used to calculate hazard ratios (HRs) for cocaine use, in the two respective cohorts, adjusted for HCV RNA and important demographic, HIV disease stage, and comorbidity confounders.

RESULTS
Eighty-seven participants (8%) had prevalent CRI. Past injection cocaine use was associated with a two-fold greater risk of prevalent CRI [OR 2.03, 95% confidence interval (CI): 0.96, 4.32]. During follow-up, 126 of 1,061 participants (12%) developed incident CRI (31 per 1,000 person-years). Compared to non-users, heavy (≥ 3 days/week) and frequent injection cocaine users (≥ 75% of follow-up time) experienced more rapid progression to CRI [HR 2.65, 95% CI: 1.35, 5.21 and HR 1.82, 95% CI: 1.07, 3.07, respectively]. There was no association between chronic HCV and CRI in either cohort.

CONCLUSIONS
After accounting for HCV RNA, frequent and cumulative injection cocaine abuse were associated with CRI progression and should be taken into consideration when evaluating impaired renal function in HIV-HCV co-infection.