Frequent injection cocaine use increases the risk of renal impairment among hepatitis C and HIV coinfected patients

AIDS. 2016 Jun 1;30(9):1403-311. doi: 10.1097/QAD.0000000000001060.


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 coinfected patients.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Canada / epidemiology
  • Cocaine / administration & dosage*
  • Coinfection / complications*
  • Dopamine Uptake Inhibitors / administration & dosage*
  • Female
  • HIV Infections / complications*
  • Hepatitis C, Chronic / complications*
  • Humans
  • Kidney Failure, Chronic / epidemiology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Assessment
  • Substance Abuse, Intravenous / complications*


  • Dopamine Uptake Inhibitors
  • Cocaine