title: Opioid use and risk of liver fibrosis in HIV/hepatitis C virus-coinfected patients in Canada.
abstract: OBJECTIVE
  Opioid use and opioid-related mortality have increased dramatically since the 1990s in North America. The effect of opioids on the liver is incompletely understood. Some studies have suggested that opioids cause liver damage and others have failed to show any harm. HIV/hepatitis C virus (HCV)-coinfected persons may be particularly vulnerable to factors increasing liver fibrosis. We aimed to describe opioid use in an HIV/HCV-coinfected population in Canada and to estimate the association between opioid use and liver fibrosis.
  
  
  METHODS
  We conducted a cross-sectional descriptive analysis of the Canadian Co-infection Cohort Study data to characterize opioid use. We then conducted a longitudinal analysis to assess the average change in aspartate aminotransferase-to-platelet ratio index (APRI) score associated with opioid use using a generalized estimating equation with linear regression. We assessed the progression to significant liver fibrosis (APRI ≥ 1.5) associated with opioid use with pooled logistic regression.
  
  
  RESULTS
  In the 6 months preceding cohort entry, 32% of the participants had received an opioid prescription, 28% had used opioids illicitly and 18% had both received a prescription and used opioids illicitly. Neither prescribed nor illicit opioid use was associated with a change in the median APRI score [exp(β) 0.99 (95% confidence interval (CI) 0.82, 1.12) and exp(β) 0.95 (95% CI 0.81, 1.10), respectively] or with faster progression to liver fibrosis [hazard odds ratio (HOR) 1.20 (95% CI 0.73, 1.67) and HOR 1.09 (95% CI 0.63, 1.55), respectively].
  
  
  CONCLUSIONS
  Although opioids were commonly used both legally and illegally in our cohort, we were unable to demonstrate a negative impact on liver fibrosis progression.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Brunet
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: E E M
authors.initials: EE
authors.lastname: Moodie
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.|Chronic Viral Illness Service, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Cox
authors.affiliation: Southern Alberta HIV Clinic, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.affiliation: The Ottawa Hospital-General Campus, Ottawa, Ontario, Canada.|CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada.|University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada.|Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Rachlis
authors.affiliation: CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada.|BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Hull
authors.affiliation: Chronic Viral Illness Service, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada.|CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada.
authors.forename: M B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002170:Canada; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D000701:Analgesics, Opioid; D001219:Aspartate Aminotransferases
keywords: HIV; hepatitis C; liver fibrosis; opioids