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

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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 coinfected patients.Methods:

Data from 1129 participants in the Canadian Co-Infection Cohort with baseline and follow-up serum creatinine measurements between 2003 and 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 below 70 ml/min per 1.73 m2. Multivariate logistic regression was used to calculate odds ratios, and discrete-time proportional-hazards models were used to calculate hazard ratios 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 [odds ratio 2.03, 95% confidence interval (CI) 0.96, 4.32]. During follow-up, 126 of 1061 participants (12%) developed incident CRI (31 per 1000 person-years). Compared to nonusers, heavy (≥ 3 days/week) and frequent injection cocaine users (≥75% of follow-up time) experienced more rapid progression to CRI (hazard ratio 2.65, 95% CI 1.35, 5.21; and hazard ratio 1.82, 95% CI 1.07, 3.07, respectively). There was no association between chronic HCV and CRI in either cohort.
Conclusion:

After accounting for HCV RNA, frequent and cumulative injection cocaine abuse was associated with CRI progression and should be taken into consideration when evaluating impaired renal function in HIV–HCV coinfection.
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Keywords: chronic hepatitis C; cocaine, coinfection, HIV; intravenous substance abuse; renal insufficiency

Document Type: Research Article

Affiliations: 1: McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montréal, Québec 2: The Ottawa Hospital-General Campus, Ottawa, Ontario 3: Centre Hospitalier de l’Université de Montréal – Notre-Dame, Montréal, Québec 4: University Health Network, University of Toronto, Toronto, Ontario 5: Southern Alberta HIV Clinic, Calgary, Alberta 6: McGill University, Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, Montréal, Québec 7: .

Publication date: June 1, 2016

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