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.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 Saint-Denis, Montréal, Quebec, H2X 0A9, Canada. valerie.martel-laferriere@umontreal.ca.
authors.forename: Valérie
authors.initials: V
authors.lastname: Martel-Laferrière
authors.affiliation: McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
authors.forename: Roy
authors.initials: R
authors.lastname: Nitulescu
authors.affiliation: McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cox
authors.affiliation: Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, Ontario, K1H 8L6, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia, V5Z 1M9, Canada.|B.C. Centre for Disease Control (BCCDC), 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
authors.affiliation: Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 Saint-Denis, Montréal, Quebec, H2X 0A9, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rouleau
authors.affiliation: University Health Network, 101 College, Toronto, Ontario, M5G 1L7, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
authors.forename: Leo
authors.initials: L
authors.lastname: Wong
authors.affiliation: McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada. marina.klein@mcgill.ca.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood*; D001792:Blood Platelets; D018791:CD4 Lymphocyte Count; D002170:Canada; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology; D015897:Comorbidity; D016578:Crack Cocaine; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D016578:Crack Cocaine; D012367:RNA, Viral; D001219:Aspartate Aminotransferases
keywords: APRI score; Cocaine; HIV; Liver fibrosis