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J Infect Dis. 2015 Sep 15;212(6):924-33. doi: 10.1093/infdis/jiv147. Epub 2015 Mar 9.

Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women.

Author information

1
Division of Infectious Diseases Division of Center for AIDS Research Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology.
2
Division of Infectious Diseases Division of Center for AIDS Research.
3
Healthcare Analytics Unit, Children's Hospital of Philadelphia.
4
Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology.
5
Division of Rheumatology, Department of Medicine.
6
Department of Laboratory Medicine, University of Washington, Seattle.
7
Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania.
8
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia.
9
Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology Department of Pediatrics and Medicine, Stanford University, California.

Abstract

BACKGROUND:

Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibial peripheral quantitative computed tomography to evaluate skeletal parameters in women, by HIV/HCV status.

METHODS:

We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined with peripheral quantitative computed tomography. Race-specific z scores for age were generated using 263 female reference participants without HIV infection or liver disease.

RESULTS:

Coinfected participants had lower mean z scores for trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) than reference participants (all P < .001). The smaller cortical dimensions were due to greater mean z scores for endosteal circumference (+0.67; P < .001) and comparable z scores for periosteal circumference (+0.04; P = .87). Trabecular volumetric BMD was lower in coinfected than in HCV- or HIV-monoinfected participants. HCV-infected women with stage 3-4 liver fibrosis had lower mean z scores for trabecular volumetric BMD, cortical thickness, and total hip BMD those with stage 0-2 fibrosis.

CONCLUSIONS:

Compared with healthy reference patients, HIV/HCV-coinfected women had decreased tibial trabecular volumetric BMD, diminished cortical dimensions, and significant endocortical bone loss.

KEYWORDS:

HIV; bone; coinfection; hepatitis C virus; peripheral quantitative computed tomography

PMID:
25754980
PMCID:
PMC4548465
DOI:
10.1093/infdis/jiv147
[Indexed for MEDLINE]
Free PMC Article

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