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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
HIV/HCV Coinfected People More Likely to Sustain Fractures Related to Bone Loss
Considerable research has shown that HIV positive people tend to have lower bone mineral density on average and a higher risk of osteoporosis and fractures compared with their HIV negative counterparts. Hepatitis C virus (HCV) infection is also associated with bone problems, especially when it progresses to liver cirrhosis.
Osteoporosis may be caused by toxic damage to the bones or metabolic changes that lead to an imbalance of bone production and resorption. Bone mineral density normally declines with age and is linked to hormone and vitamin D levels. It is not yet fully understood whether accelerated bone loss in people with HIV or HCV is attributable to the viruses themselves, drugs used to treat them, or some other factors.
In the present study, Roger Bedimo from the Veterans Administration North Texas Healthcare System in Dallas retrospectively assessed the incidence of osteoporotic fractures among 56,660 HIV positive patients enrolled in the Veterans Affairs' Clinical Case Registry between 1988 and 2009; 17,281, or 31%, were coinfected with hepatitis C.
were men and the average age was 45 years. About two-thirds had taken
antiretroviral therapy (ART), for an average duration of about 4 years.
Participants were followed for about 5 years on average, contributing
a total 305,237 person-years of observation.
Based on these findings, the investigators concluded, "HCV coinfection is associated with higher risk of osteoporotic fractures among HIV-infected patients."
"Risk of osteoporotic fractures appears to be increasing in the HAART era among HIV/HCV patients," they continued.
The researchers suggested that exposure to ART "appears to be protective" against osteoporotic fractures, but noted that high overall mortality in the pre-HAART era may not have allowed patients to survive long enough to develop fractures.
It is possible that ART is not actually protective, but rather is "a surrogate measures of patients with better care."
Investigator affiliations: VA North Texas Healthcare System, Medicine, Dallas, TX; University of Alabama at Birmingham, Birmingham, AL; University of Texas Southwestern Medical Center, Medicine, Dallas, TX.