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Spotlight Series on Hepatitis C

Viral Infections -- Hep C and HIV Linked to Hip Fractures

November 22, 2012

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Results -- Comparing Fracture Risks Between Co-Infected and Uninfected People

Overall, ART-treated participants had a greater risk for hip fracture (about two-fold) compared to uninfected people. In general, for co-infected men and women fracture risk rose with age.


Results -- Comparing Fracture Risks Between Co-Infected People and People With HIV Monoinfection

Overall, ART-using co-infected participants had a greater risk for hip fracture than ART-using participants with HIV monoinfection. This increased risk differed by gender, with co-infected ART-using women having a 76% increased risk and co-infected ART-using men having a 36% increased risk for hip fracture.


Results -- Comparing Fracture Risks Between Co-Infected People and People With HCV Monoinfection

Among all HIV-HCV co-infected people, there was a 38% increased risk for hip fracture compared to HCV-monoinfected people.


Key Findings

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1. HIV-HCV co-infected people who use ART have increased risk for hip fractures compared to the following groups of people:

  • HCV monoinfection
  • HIV moninfection + use of ART
  • people who have neither HIV nor HCV

2. HCV-monoinfected people have increased risk for hip fracture compared to people without HCV (or HIV) who are under the age of 70.


Viral Infections and Bones

Researchers are not certain why there was an increased risk for hip fractures among HCV-positive people. We have already mentioned the potential impact of chronic inflammation and liver injury on bone health. However, more research needs to be done to fully understand the general impact of chronic HCV infection on bone health.


Other Factors That Could Have Affected Bone Health

The research team noted that certain factors that are relatively common among some HCV-positive people could also play a role in the loss of bone mineral density, including the following:

  • use of street drugs
  • smoking
  • excessive intake of alcohol
  • poor nutrition
  • length of time infected with HCV or HIV

Their data set did not include these missing factors and that is one weakness that may have affected the study's conclusions.


Focus on HIV and Its Treatment

Other studies have found that HIV-positive people (and even some people at high risk for HIV infection) tend to have reduced bone mineral density. The reason(s) for this are not clear. Chronic HIV infection also causes inflammation that is only partially reduced with treatment. Less-than-optimal levels of vitamin D are also relatively common in HIV-positive people. Deficiencies of testosterone, reduced muscle mass and perhaps other factors could play a role in thinning bones as well.

The researchers attempted to assess the impact on bone health of anti-HIV drugs that were prescribed for participants' initial treatment. However, due to built-in limitations of the study's retrospective design, researchers cannot draw firm conclusions about the long-term impact of such drugs on the risk of hip fracture.


Size and Strengths

The study is unusual because of its immense size, and this is a great strength. That the researchers compared different groups of people with and without different viral infections is another strength. The study's findings are generally sound -- there is an increased risk for hip fractures among people with HCV infection, including people who are co-infected with HCV and HIV. A previous French study has also found an increased risk for fractures among co-infected people.

Now other research teams need to investigate precisely why HCV is associated with reduced bone mineral density and explore interventions that can improve bone health in people with HCV monoinfection as well as those with HCV-HIV co-infection.


Resources


References

  1. Lo Re V 3rd, Volk J, Newcomb CW, et al. Risk of hip fracture associated with hepatitis C virus infection and hepatitis C/human immunodeficiency virus coinfection. Hepatology. 2012 Nov;56(5):1688-98.
  2. Li Vecchi V, Soresi M, Giannitrapani L, et al. Dairy calcium intake and lifestyle risk factors for bone loss in HIV-infected and uninfected Mediterranean subjects. BMC Infectious Diseases. 2012 Aug 15;12:192.
  3. Walker Harris V, Sutcliffe CG, et al. Hip bone geometry in HIV/HCV-co-infected men and healthy controls. Osteoporosis International. 2012 Jun;23(6):1779-87.
  4. Collin F, Duval X, Le Moing V, et al. Ten-year incidence and risk factors of bone fractures in a cohort of treated HIV1-infected adults. AIDS. 2009 May 15;23(8):1021-4.
  5. Grijsen ML, Vrouenraets SM, Wit FW, et al. Low bone mineral density in men who have sex with men regardless of HIV status. Journal of Infectious Diseases. 2012; in press.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.

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