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

BMC Infect Dis. 2017 Jan 17;17(1):80. doi: 10.1186/s12879-017-2196-0.

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.

MeSH terms

  • Adult
  • Alcoholism / epidemiology
  • Anti-HIV Agents / therapeutic use
  • Aspartate Aminotransferases / blood*
  • Blood Platelets
  • CD4 Lymphocyte Count
  • Canada
  • Cocaine-Related Disorders / epidemiology*
  • Cohort Studies
  • Coinfection / epidemiology
  • Comorbidity
  • Crack Cocaine*
  • Disease Progression
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • Hepatitis C, Chronic / epidemiology*
  • Humans
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / epidemiology
  • Male
  • Middle Aged
  • Platelet Count*
  • Proportional Hazards Models
  • Prospective Studies
  • RNA, Viral / blood
  • Viral Load

Substances

  • Anti-HIV Agents
  • Crack Cocaine
  • RNA, Viral
  • Aspartate Aminotransferases

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