Frequent Injection Cocaine Use Increases the Risk of Renal Impairment among Hepatitis C and HIV Co-Infected Patients
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.
- 1McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montréal, Québec bThe Ottawa Hospital-General Campus, Ottawa, Ontario cCentre Hospitalier de l'Université de Montréal - Notre-Dame, Montréal, Québec, Canada dUniversity Health Network, University of Toronto, Toronto, Ontario eSouthern Alberta HIV Clinic, Calgary, Alberta fMcGill University, Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, Montréal, Québec gChronic Viral Illness Service, McGill University Health Centre, Montréal, Québec.
- AIDS. 2016 Feb 8.
No comments:
Post a Comment