Controlled HIV viral replication, not liver disease severity associated with low bone mineral density in HIV/HCV co-infection

Johns Hopkins School of Medicine, Baltimore, MD, USA.
Journal of Hepatology (Impact Factor: 11.34). 02/2011; 55(4):770-6. DOI: 10.1016/j.jhep.2011.01.035
Source: PubMed


To evaluate the prevalence and risk factors for low bone mineral density (BMD) in persons co-infected with HIV and Hepatitis C.
HIV/HCV co-infected study participants (n=179) were recruited into a prospective cohort and underwent dual-energy X-ray absorptiometry (DXA) within 1 year of a liver biopsy. Fibrosis staging was evaluated according to the METAVIR system. Osteoporosis was defined as a T-score ≤-2.5. Z-scores at the total hip, femoral neck, and lumbar spine were used as the primary outcome variables to assess the association between degree of liver disease, HIV-related variables, and BMD.
The population was 65% male, 85% Black with mean age 50.3 years. The prevalence of osteoporosis either at the total hip, femoral neck, or lumbar spine was 28%, with 5% having osteoporosis of the total hip, 6% at the femoral neck, 25% at the spine. The mean Z-scores (standard deviation) were -0.42 (1.01) at the total hip, -0.16 (1.05) at the femoral neck, and -0.82 (1.55) at the lumbar spine. In multivariable models, controlled HIV replication (HIV RNA <400 copies/ml vs. ≥400 copies/ml) was associated with lower Z-scores (mean ± standard error) at the total hip (-0.44 ± 0.17, p = 0.01), femoral neck (-0.59 ± 0.18, p = 0.001), and the spine (-0.98 ± 0.27, p = 0.0005). There was no association between degree of liver fibrosis and Z-score.
Osteoporosis was very common in this population of predominately African-American HIV/HCV co-infected patients, particularly at the spine. Lower BMD was associated with controlled HIV replication, but not liver disease severity.

Download full-text


Available from: Diala El-Maouche, Oct 06, 2015
15 Reads
  • Source
    • "In addition, in a study on osteoporosis in patients with end- stage liver disease caused by hepatitis C and ALD, Carey et al. [25] showed that hepatitis C patients had the lowest lumbar bone density and ALD patients had the highest bone density. In a prospective cohort study [28], El-Maouche et al. showed that osteoporosis was very common in the lumbar spine among the African-American patients with HIV/HCV co-infection. It is unclear about the mechanism between HCV infection and bone loss of lumbar spine. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The average prevalence of hepatitis C virus (HCV) infection in renal transplant recipients is 10%. Studies of these patients with HCV infection usually focuses on long-term graft survival and patient survival. Studies of the correlation between HCV infection and bone mineral density (BMD) in renal transplant patients are limited. The aim of this study was to investigate whether HCV infection is a risk factor for BMD change during a short follow-up period. Seventy-six renal transplant recipients underwent 2 separate dual-energy X-ray absorptiometry (DXA) scans during a mean period of 14 months. Fifteen patients were HCV infection. First bone mineral density (BMD) at the lumbar spine, hip, and femoral neck was determined using dual-energy X-ray absorptiometry (DXA) between September 2008 and March 2009. After that, 34 patients took alendronate sodium 70 mg per week. Subgroups risk factors analysis was also performed into with or without alendronate. Immunosuppressive agents, bisphosphonates, patient characteristics, and biochemical factors were analyzed to identify associations with BMD. After 14 months, in 76 patients, BMD of the lumbar spine had significantly increased (from 0.9 g/cm(2) to 0.92 g/cm(2), p<0.001), whereas BMD of the hip and femoral neck had not. Multiple linear regression analysis showed that HCV infection was negatively associated with BMD change in the lumbar spine ( β : -0.247, 95% CI, -0.035 to -0.002; p = 0.028). Moreover, in subgroup analysis, among 42 patients without alendronate, multiple linear regression analysis showed HCV infection was a risk factor for adverse BMD change of the lumbar spine ( β : -0.371, 95% CI, -0.043 to -0.003; p = 0.023). HCV infection in renal transplant recipients was a negative risk factor for BMD change in the lumbar spine. Moreover, alendronate may be able to reverse the negative effect of HCV infection on bone in renal transplant recipients.
    PLoS ONE 05/2013; 8(5):e63263. DOI:10.1371/journal.pone.0063263 · 3.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This text mainly follows my talk at the conference “Unity of Mathematics” (Harvard, September 2003), devoted to the 90th birthday of I. M. Gelfand. I introduce some new notions that are related to several old ideas of I. M. and try to give a draft of the future development of this area, which includes the representation theory of inductive families of groups and algebras and Fourier analysis on such groups. I also include a few reminiscences about I. M. as my guide.
    05/2007: pages 619-631;
  • [Show abstract] [Hide abstract]
    ABSTRACT: People with both HIV and hepatitis C are more likely than those with HIV alone to have wrist, hip, and spine fractures. We compared hip strength between HIV/HCV-co-infected men and healthy men and found that HIV/HCV-co-infected men had decreased hip strength due to lower lean body mass. Hepatitis C co-infection is a risk factor for fragility fracture among HIV-infected populations. Whether bone strength is compromised in HIV/HCV-co-infected patients is unknown. We compared dual-energy x-ray absorptiometry (DXA)-derived hip geometry, a measure of bone strength, in 88 HIV/HCV-co-infected men from the Johns Hopkins HIV Clinic to 289 men of similar age and race and without HIV or HCV from the Boston Area Community Health Survey/Bone Survey. Hip geometry was assessed at the narrow neck, intertrochanter, and shaft using hip structural analysis. Lean body mass (LBM), total fat mass (FM), and fat mass ratio (FMR) were measured by whole-body DXA. Linear regression was used to identify body composition parameters that accounted for differences in bone strength between cohorts. HIV/HCV-co-infected men had lower BMI, LBM, and FM and higher FMR compared to controls (all p < 0.05). At the narrow neck, significant differences were observed between HIV/HCV-co-infected men and controls in bone mineral density, cross-sectional area, section modulus, buckling ratio, and centroid position. After adjustment for race, age, smoking status, height, and weight, only buckling ratio and centroid position remained significantly different between cohorts (all p < 0.05). Substituting LBM, FM, and FMR for weight in the multivariate model revealed that differences in LBM, but not FM or FMR, accounted for differences in all narrow neck parameters between cohorts, except buckling ratio and centroid position. HIV/HCV-co-infected men have compromised hip strength at the narrow neck compared to uninfected controls, which is attributable in large part to lower lean body mass.
    Osteoporosis International 09/2011; 23(6):1779-87. DOI:10.1007/s00198-011-1769-9 · 4.17 Impact Factor
Show more