HCV co-infection is associated with a high risk of osteoporotic fractures among HIV-infected patients
Presented by Roger Bedimo (United States).
R. Bedimo1, A. Westfall2, H. Drechsler1, N. Maalouf3
1VA North Texas Healthcare System, Medicine, Dallas, United States, 2University of Alabama at Birmingham, Medicine, Birmingham, United States, 3University of Texas Southwestern Medical Center, Medicine, Dallas, United States
Background: Decreased bone mineral density is increasingly reported in the aging HIV-positive population. An estimated 15 to 30% of HIV-infected patients are co-infected with hepatitis C, which by itself is associated with osteoporosis. While these findings have raised concern for increased fracture risk, few studies have assessed this risk.
Methods: Patients with any osteoporotic fracture (defined as wrist, vertebral or hip fracture) occurring after HIV diagnosis were identified by ICD9 code in the Veterans Affairs' Clinical Case Registry in the HAART era (1996-2004). The incidence of osteoporotic fractures was calculated among HIV mono-infected and HIV/HCV co-infected patients. The impact of age, race, antiretroviral therapy, and chronic kidney disease (CKD) on fracture risk was also evaluated
Results: 19,398 HIV-infected patients (97.5% male; mean age: 46 years) contributed 76,462 patient-years of follow-up (median follow-up = 3.61 years). During this period, 200 individual patients sustained at least one osteoporotic fracture (20 vertebral, 114 wrist and 74 hip). Fracture rates/1000 patient-years for HIV and HIV/HCV patients were 2.36 (CI: 1.97 - 2.82) and 3.13 (2.51 - 3.89) respectively. The following table summarizes the factors predicting osteoporotic fracture among HIV-infected patients in a multi-variable Cox model.
[factors predicting osteoporotic fracture in HIV]
|Risk Factors||Hazard Ratio (95% Confidence Interval; p value)|
| ||Univariate Analysis||Multi-variable Analysis|
|HCV Co-infection||1.33 (1.00 - 1.76; p = 0.05)||1.45 (1.07 - 1.95; p = 0.02|
|CKD (estimated glomerular filtration rate <60)||1.42 (0.84 - 2.41; p = 0.19)||0.94 (0.55 - 1.62; p = 0.83)|
|Black Race||0.62 (0.46 - 0.84; p = 0.002)||0.59 (0.43 - 0.80; p < 0.001|
|Age (per 10 year increase)||1.36 (1.19 - 1.56; p <0.0001)||1.34 (1.16 - 1.56; p < 0.001)|
|Year of HAART Use||1.02 (0.90 - 1.15; p = 0.78)||0.93 (0.82 - 1.06; p = 0.28)|
Conclusions: In the HAART era, HCV co-infection and advancing age are associated with a higher risk of osteoporotic fractures in HIV-infected patients. Cumulative years of HAART use and CKD are not. As described in the general population, Black race was protective.
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