title: Frequent injection cocaine use increases the risk of renal impairment among hepatitis C and HIV coinfected patients.
abstract: To examine the association between injection cocaine use, hepatitis C virus (HCV) infection, and chronic renal impairment (CRI).
  
  
  
  Prospective observational cohort study of HIV-HCV coinfected patients.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: aMcGill 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 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, Canada.
authors: Carmine
authors: C
authors: Rossi
authors: Joseph
authors: J
authors: Cox
authors: Curtis
authors: C
authors: Cooper
authors: Valérie
authors: V
authors: Martel-Laferrière
authors: Sharon
authors: S
authors: Walmsley
authors: John
authors: J
authors: Gill
authors: Ruth
authors: R
authors: Sapir-Pichhadze
authors: Erica E M
authors: EE
authors: Moodie
authors: Marina B
authors: MB
authors: Klein
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003042:Cocaine / Q000008:administration & dosage*; D060085:Coinfection / Q000150:complications*; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine