Cocaine Use and Liver Disease are Associated with All-Cause Mortality in the Miami Adult Studies in HIV (MASH) Cohort

Abstract

Objective Liver disease is a frequent cause of morbidity and mortality in HIV infection. We examined the relationship of cocaine use, liver disease progression and mortality in an HIV-infected cohort. Methods Consent was obtained from 487 HIV+ participants, a subset of the Miami Adult Studies on HIV (MASH) cohort. Participants were eligible if they were followed for at least two years, completed questionnaires on demographics and illicit drug use and had complete metabolic panels, CD4 cell counts and HIV-viral loads. FIB-4 was calculated and cut-off points were used for staging liver fibrosis. Death certificates were obtained. Results Participants were 65% men, 69% Black and 81% were on ART at recruitment. Cocaine was used by 32% of participants and 29% were HIV/HCV co-infected. Mean age was 46.9 ± 7.7 years, mean CD4 cell count was 501.9 ± 346.7 cells/μL and mean viral load was 2.75 ± 1.3 log10 copies/mL at baseline. During the follow-up, 27 patients died, with a mortality rate of 28.2/1000 person-year. Cocaine was used by 48% of those who died (specific mortality rate was 13/1000 person-year). Those who died were more likely to use cocaine (HR=3.8, P=0.006) and have more advanced liver fibrosis (HR=1.34, P<0.0001), adjusting for age, gender, CD4 cell count and HIV-viral load at baseline and over time. Among the HIV mono-infected participants, cocaine users were 5 times more likely to die (OR=5.09, P=0.006) than participants who did not use cocaine. Conclusion Cocaine use and liver fibrosis are strong and independent predictors of mortality in HIV infected and HIV/HCV co-infected adults. Effective interventions to reduce cocaine use among people living with HIV (PHLW) are needed.

Fibrosis-4 index predicts mortality in HIV/HCV co-infected patients receiving combination antiretroviral therapy in rural China

“…In the present study, both baseline FIB-4 higher than 3.25, indicating advanced liver fibrosis, and FIB-4 progressing from mild to advanced fibrosis during follow-up were found to be independent predictors for all-cause mortality among HIV/HCV co-infected participants under cART. This observation is consistent with studies conducted in the western countries (31)(32)(33). One large scale cohort conducted in Italy followed up 3,475 HIV patients with or without HCV reported that FIB-4 at cART initiation and its change independently predicted liver related death (34).…”

The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care

“…Further details related to the methodology of the original project can be found in a paper entitled, ‘Cocaine Use and Liver Disease are Associated with All-Cause Mortality in the Miami Adult Studies in HIV (MASH) Cohort’. 15 This is a secondary analysis of a prospective cohort study involving 407 individuals living with HIV and residing in the south Florida region. Participants were a subset of the more than 800 participants from the MASH cohort who have been followed from 2009 to 2014.…”

Editorial on Mortality

“…In Miami-Dade County, where the use of cocaine is frequent among PLWH and the incidence of HIV is the highest in the United States [4], cocaine use has been associated with increased mortality in the Miami Adult Studies on HIV (MASH) cohort [5]. Cocaine use was associated with, HIV-related mortality and cardio-pulmonary deaths, the two main causes of death in this report [5].…”

“…The results from the MASH cohort suggest that cocaine use may precipitate death in this population through behavioral and biological effects [5][6][7][8][9][10]. Behavioral factors such as engaging in illegal and addictive drug use will lessen the possibility of early HIV testing, and reduce the potential for accessing and adhering to antiretroviral treatment.…”

“…Biological effects of cocaine use such as overdose, cardiovascular and pulmonary events and progression of liver disease increase morbidity and mortality in this population [5,9,10]. PLWH who use cocaine are at a higher risk of cocaine overdose, as well as toxicity by other additives/contaminants of the illegal drug.…”