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Published on: July 24, 2013
The Differential Effects of Human Immunodeficiency Virus and Hepatitis C Virus on Bone Microarchitecture and Fracture
Roger J Bedimo1, Beverley Adams-Huet2, John Poindexter3
1Department of Medicine, Veterans Affairs North Texas Health Care System and the University of Texas Southwestern Medical Center at Dallas.
Insights
Hepatitis C virus (HCV) infection, but not HIV, is linked to poorer bone microarchitecture, as measured by trabecular bone score (TBS). This may explain increased fracture risk in coinfected individuals, suggesting TBS can aid fracture risk prediction.
Area of Science:
- Bone Metabolism and Health
- Viral Infections and Bone Health
- Osteoporosis Research
Background:
- Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected individuals face higher osteoporotic fracture risk than HIV-monoinfected individuals.
- This increased risk occurs despite similar bone mineral density (BMD) between coinfected and monoinfected groups.
- Bone microarchitecture, assessed by trabecular bone score (TBS), was investigated as a potential explanatory factor.
Purpose of the Study:
- To evaluate if changes in bone microarchitecture (TBS) explain the higher fracture risk in HIV/HCV coinfection.
- To compare TBS and BMD across HIV-infected, HCV-infected, HIV/HCV-coinfected, and uninfected individuals.
- To identify predictors of BMD and TBS and the impact of HCV severity and tenofovir disoproxil fumarate (TDF) use.
Main Methods:
- Prospective, cross-sectional cohort study of 532 male subjects.
- Analysis of covariance compared BMD and TBS between groups, controlling for covariates.
- Linear regression evaluated predictors of BMD and TBS.
Main Results:
- Hepatitis C virus (HCV) infection was associated with lower TBS, indicating poorer bone microarchitecture.
- Human immunodeficiency virus (HIV) infection alone was not associated with lower TBS.
- HIV/HCV-coinfected subjects exhibited significantly lower TBS scores compared to all other groups.
Conclusions:
- HCV infection is linked to lumbar spine microarchitectural deterioration, as indicated by low TBS scores.
- These microstructural abnormalities likely contribute to the elevated fracture risk observed in HCV infection.
- Trabecular bone score (TBS) shows potential for improving fracture risk prediction in HCV-infected individuals.
Background:
Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected individuals have a significantly greater osteoporotic fracture risk than HIV-monoinfected persons, despite the fact that HIV/HCV coinfection has not been associated with lower bone mineral density (BMD) than HIV or HCV alone. To evaluate if changes in bone microarchitecture, measured by trabecular bone score (TBS), could explain these differences, we performed a prospective, cross-sectional cohort study of virologically suppressed HIV-infected subjects, untreated HCV-infected subjects, HIV/HCV-coinfected subjects, and uninfected controls.
Methods:
We enrolled 532 male subjects: 57 HIV/HCV coinfected, 174 HIV infected, 123 HCV infected, and 178 controls. We conducted analysis of covariance comparing BMD and TBS between groups, controlling for age, race, body mass index, and smoking. We used linear regression to evaluate predictors of BMD and TBS and evaluated the effects of severity of HCV infection and tenofovir disoproxil fumarate use.
Results:
Despite both infections being associated with decreased BMD, only HCV, but not HIV, was associated with lower TBS score. Also, HIV/HCV-coinfected subjects had lower TBS scores than HIV-monoinfected, HCV-monoinfected, and uninfected subjects. Neither the use of TDF or HCV viremia nor the severity of HCV liver disease was associated with lower TBS.
Conclusions:
HCV infection is associated with microarchitectural changes at the lumbar spine as assessed by the low TBS score, suggesting that microstructural abnormalities underlie some of the higher fracture risk in HCV infection. TBS might improve fracture risk prediction in HCV infection.
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