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HIV/HCV co-infection associated with increased risk of osteoporosis and fractures
Michael Carter, 2014-07-08 10:10:00
Co-infection with HIV and hepatitis C virus (HCV) is associated with increased risks of low bone mineral density (BMD) and facture, investigators report in the online edition of AIDS. Results of 15 separate studies showed that co-infected patients had a higher risk of osteoporosis than HIV-mono-infected individuals, and that fracture incidence was higher among co-infected individuals compared to both HIV-mono-infected patients and healthy controls. The authors believe their findings underline the importance of monitoring bone mineral density in all older co-infected patients.
“Our review found that HIV/HCV-co-infected individuals have a modestly increased risk of osteoporosis and fractures compared with HIV-mono-infected controls, and substantially higher risk than uninfected controls,” comment the researchers.
Chronic HCV infection is associated with an increased risk of osteoporosis. HIV infectionand antiretroviral therapy have also been associated with an increased risk of low bone mineral density and fractures. Large numbers of patients are co-infected with HIV and HCV. A team of US investigators therefore wanted to see if co-infected patients had an increased risk of osteoporosis and fractures compared to HIV-mono-infected patients and uninfected individuals.
They therefore conducted a systematic review and meta-analysis of studies published or presented at major conferences before 2013 that compared these outcomes between co-infected patients, HIV-mono-infected patients and healthy controls.
A total of 15 studies were eligible for inclusion: nine provided data on osteoporosis and six reported on fracture risk. The studies were conducted in the US, Europe and Taiwan. Four studies included women only and one included only men. Same size varied from 22 post-menopausal women to approximately 37,000 patients receiving care in the US.
Prevalence of osteoporosis in co-infected patients ranged from 5%-45%. The pooled estimate was 22%. Co-infection was associated with a significantly increased risk of low bone mineral density compared to HIV mono-infection (OR = 1.63; 95% CI, 1.27-2.11). The risk was little altered after the authors excluded the study with post-menopausal women (overall prevalence= 20%; OR = 1.61; 95% CI, 1.23-2.12).
Co-infection was also associated with an increased fracture incidence. The risk was significantly increased when co-infected and HIV-mono-infected patients were compared (IRR = 1.77; 95% CI, 1.44-2.18). Co-infected patients also had a significantly higher incidence of fragility fractures compared to HIV-mono-infected patients (IRR = 1.70; 95% CI, 1.18-2.43). Moreover, fracture incidence was substantially higher among co-infected patients when compared to uninfected controls (IRR = 2.95; 95% CI, 2.17-4.01).
Factors independently associated with an increased risk of osteoporosis were HIV/HCV co-infection, older age, lower BMI, post-menopausal status and longer duration of therapy with an HIV protease inhibitor. Smoking, low physical activity and methadone use were identified as risk factors in some studies.
Risk factors for fracture included co-infection, older age, smoking, white race, alcohol and substance abuse, diabetes and low BMI. Some studies also found that intravenous drug use or opioid therapy, hormone replacement therapy or oral contraception, kidney function, menopause and peripheral neuropathy were also risk factors. In multivariate analysis, co-infection, older age, white race, alcohol and substance abuse, kidney function and diabetes all remained associated with a significant increase in the risk of fracture.
“This systematic review and meta-analysis suggests an increase in osteoporosis in HIV/HCV-co-infected individuals,” comment the authors. “HIV/HCV-co-infection is also associated with a pooled fracture IRR of 1.77 when compared with HIV mono-infection, with higher IRR values for traumatic fractures.”
They conclude their findings “confirm the importance of risk modification and DXA screening at age 50 for prevention of osteoporosis and fractures in HIV/HCV-co-infected individuals.”
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