Research Papers

@article{V2017,

title = {Cocaine/crack use is not associated with fibrosis progression measured by AST-to-Platelet Ratio Index in HIV-HCV co-infected patients: a cohort study},

author = {Martel-Laferrière V and Rollet-Kurhajec KC and Cox J and Cooper C and Tyndall M and Rouleau D and Walmsley S and Wong L and Klein MB},

doi = {10.1186/s12879-017-2196-0},

year  = {2017},

date = {2017-01-17},

journal = {BMC Infect Dis.},

abstract = {Background: Cocaine and crack use has been associated with HIV and HCV infections, but its consequences on HCV progression have not been well established. We analyzed the impact of cocaine/crack use on liver fibrosis progression in a cohort of HIV-HCV co-infected patients.



Methods: A Canadian multicenter prospective cohort study followed 1238 HIV-HCV co-infected persons every 6 months between 2003 and 2013. Data were analyzed from 573 patients with positive HCV RNA, not on HCV treatment, without significant liver fibrosis (AST-to-Platelet Ratio Index (APRI) <1.5) or history of end-stage liver disease at baseline, and having at least two study visits. Recent cocaine/crack use was defined as use within 6 months of cohort entry. Incidence rates of progression to significant fibrosis (APRI ≥ 1.5) were determined according to recent cocaine/crack use. Cox Proportional Hazards models were used to assess the association between time-updated cocaine/crack use and progression to APRI ≥ 1.5 adjusting for age, sex, HCV duration, baseline ln(APRI), and time-updated alcohol abuse, history of other drug use and CD4+ cell count.



Results: At baseline, 211 persons (37%) were recent cocaine/crack users and 501 (87%) ever used cocaine/crack. Recent users did not differ from non-recent users on gender, age, and CD4+ T-cell count. Over 1599 person-years of follow up (522 PY in recent users, 887 PY in previous users and 190 PY in never users),158 (28%) persons developed significant fibrosis (9.9/100 PY; 95% CI, 8.3-11.4); 56 (27%) recent users (10.7/100 PY; 7.9-13.5), 81 (28%) previous users (9.1/100 PY; 7.1-11.1), and 21 (29%) never users (11.1/100 PY; 6.3-15.8). There was no association between ever having used or time-updated cocaine/crack use and progression to APRI ≥ 1.5 (adjusted HR (95%CI): 0.96 (0.58, 1.57) and 0.88;(0.63-1.25), respectively).



Conclusions: We could not find evidence that cocaine/crack use is associated with progression to advanced liver fibrosis in our prospective study of HIV-HCV co-infected patients.},

keywords = {APRI score, Cocaine, HIV, Liver fibrosis},

pubstate = {published},

tppubtype = {article}

}

@article{Rossi2016,

title = {Frequent injection cocaine use increases the risk of renal impairment among Hepatitis C and HIV co-infected patients},

author = {Carmine Rossi and Joseph Cox and Curtis Cooper and Valérie Martel-Laferrière and Sharon Walmsley and John Gill and Ruth Sapir-Pichhadze and Erica E. M. Moodie and Marina B. Klein},

url = {https://www.ncbi.nlm.nih.gov/pubmed/26859371},

doi = {10.1097/QAD.0000000000001060},

year  = {2016},

date = {2016-06-01},

journal = {AIDS},

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 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 m. 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.},

keywords = {Chronic hepatitis C, Co-infection, Cocaine, HIV, Intravenous substance abuse, Renal insufficiency},

pubstate = {published},

tppubtype = {article}

}