The Differential Effects of Human Immunodeficiency Virus and Hepatitis C Virus on Bone Microarchitecture and Fracture Risk

Bedimo, Roger; Adams‐Huet, Beverley; Poindexter, John R.; Brown, Geri; Farukhi, Irfan; Castanon, Rosinda; Turner, Diana; Moore, Teresa A.; Tebas, Pablo; Maalouf, Naim M.

doi:10.1093/cid/cix1011

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…Studies have suggested that TBS helps predict osteoporotic fractures and complements BMD and CRFs for FRAX prediction and monitoring of treatment effect [14–16]. Moreover, TBS may play an even greater role in assessing fracture risk in people with causes of secondary osteoporosis, including HIV infection [17–19].…”

Section: Introductionmentioning

confidence: 99%

Improved fracture prediction using different fracture risk assessment tool adjustments in HIV-infected women

Yang

Sharma

Shi

et al. 2018

Aids

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Section: Introductionmentioning

confidence: 99%

Improved fracture prediction using different fracture risk assessment tool adjustments in HIV-infected women

Yang

Sharma

Shi

et al. 2018

Aids

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“…In this study, the association between HIV and TBS remained significant irrespective of HCV positive status. However, another recent study examining four groups of men (HIV mono-infected, HCV mono-infected, HIV/HCV co-infected and HIV negative controls), reported that HCV but not HIV predicted lower TBS [ 15 ]. While we also observed lower TBS in subjects with HCV, further comparisons were not explored within this analysis given the low prevalence of HCV in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the reported adjunctive utility of TBS as a measure of bone microarchitectural quality in the general population there are few reported data in PLWH [ 15 – 18 ]. Furthermore, the sociodemoographic and clinical factors which may predict altered TBS in PLWH have not been explored in a larger contemporary mixed cohort such as is represented in the ‘Understanding the pathology of bone disease in HIV Positive persons’ (HIV UPBEAT) cohort.…”

Section: Introductionmentioning

confidence: 99%

Assessment of trabecular bone score, an index of bone microarchitecture, in HIV positive and HIV negative persons within the HIV UPBEAT cohort

McGinty

Cotter

Sabin³

et al. 2019

PLoS ONE

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IntroductionIncreased prevalence of low bone mineral density (BMD) and increased fracture incidence are observed in persons living with HIV (PLWH). The trabecular bone score (TBS) is a novel index of bone microarchitecture which improves fracture prediction independent of BMD.MethodsThe HIV UPBEAT study is a single centre, prospective cohort study that enrolled subjects with and without HIV from similar sociodemographic backgrounds for annual assessments of bone health. TBS was derived from lumbar spine (LS) dual-energy X-ray absorptiometry images. Univariate and multivariable linear regression was used to assess relationships between baseline TBS, BMD, sociodemographic and clinical factors.Results463 subjects (201 HIV positive) were included; PLWH were younger and more likely male, of non-African ethnicity and current smokers. HIV was associated with a mean reduction of 0.037 [-0.060, -0.013] (p = 0.002) in TBS. Lower TBS was also associated with male gender, non-African ethnicity, current smoking status and lower LS BMD. HIV remained associated with lower TBS after adjustment for LS BMD, age, gender and ethnicity. However, adjustment for current smoking significantly attenuated the association between HIV and TBS, with further adjustment for higher bone turnover markers largely explaining any residual association. Among the sub-group of PLWH, exposure to protease inhibitors and lower nadir CD4+ T-cell counts were both predictors of lower TBS.ConclusionsPLWH have lower TBS independent of LS BMD. However, this is largely explained by higher current smoking rates and higher bone turnover in those with HIV. Exposure to PI, but not tenofovir disproxil fumarate, also contributed to lower TBS in those with HIV.

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“…A meta-analytical review of published cross-sectional studies from 2001-2005 reveals that the prevalence of osteoporosis is 15% in HIV-infected individuals [ 12 , 13 ], and they have a greater risk of fractures than the general population [ 14 - 16 ]. Many recent studies reported that HIV/HCV-coinfection has significantly increased osteoporosis risk compared to HIV or HCV infection alone [ 17 - 20 ]. The risks of fracture in any sites and fragility fracture were also increased in HIV-infected patients [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D and Calcium Supplement Attenuate Bone Loss among HIVInfected Patients Receiving Tenofovir Disoproxil Fumarate/Emtricitabine/ Efavirenz: An Open-Label, Randomized Controlled Trial

Boontanondha

Nimitphong

Musikarat

et al. 2020

CHR

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Background: Antiretroviral therapy (ART), especially with tenofovir disoproxil fumarate (TDF), has been associated with accelerated bone turnover and leads to significant bone loss. Objective: We aimed to determine the effect of vitamin D2 and calcium on bone mineral density (BMD) in HIV-infected patients receiving TDF/emtricitabine (FTC)/efavirenz (EFV). Methods: A prospective, open-label, randomized controlled study was conducted. Eligible patients were ART naïve HIV individuals who initiated TDF/FTC/EFV. The study group received supplementation with vitamin D2 and calcium carbonate, whereas the control group was administered only ART. The primary outcome was the percentage change in total hip BMD at week 24 compared with baseline. Results: A total of 18 patients were randomized (9 in each group). The mean (standard deviation; SD) total hip BMD significantly decreased from baseline in both groups, from 0.96 (0.14) g/cm2 to 0.93 (0.13) g/cm2 in the study group (p = 0.006) and from 0.87 (0.11) g/cm2 to 0.84 (0.11) g/cm2 in the control group (p = 0.004). The mean (SD) lumbar spine BMD significantly decreased from baseline in both groups, from 1.00 (0.13) g/cm2 to 0.97 (0.13) g/cm2 (p = 0.004) in the study group and from 0.90 (0.09) g/cm3 to 0.86 (0.08) g/cm2 in the control group (p = 0.006). At week 24, the mean (SD) lumbar spine BMD was significantly greater in the study group than in the control group (p = 0.042). However, there were no significant differences in the percentage change of total hip, lumbar spine, and femoral neck BMD between both groups. No adverse events were reported. In conclusion, as early as 24 weeks after TDF initiation, a significant decline in BMD was detected. Conclusion: Vitamin D2 and calcium supplements should be considered for HIV-infected patients receiving TDF/FTC/EFV in a resource-limited setting where there are limited ART options (Clinicaltrials. gov NCT0287643).

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The Differential Effects of Human Immunodeficiency Virus and Hepatitis C Virus on Bone Microarchitecture and Fracture Risk

Abstract: HCV infection is associated with microarchitectural changes at the lumbar spine as assessed by the low TBS score, suggesting that microstructural abnormalities underlie some of the higher fracture risk in HCV infection. TBS might improve fracture risk prediction in HCV infection.

Cited by 15 publications

References 31 publications

Improved fracture prediction using different fracture risk assessment tool adjustments in HIV-infected women

Improved fracture prediction using different fracture risk assessment tool adjustments in HIV-infected women

Assessment of trabecular bone score, an index of bone microarchitecture, in HIV positive and HIV negative persons within the HIV UPBEAT cohort

Vitamin D and Calcium Supplement Attenuate Bone Loss among HIVInfected Patients Receiving Tenofovir Disoproxil Fumarate/Emtricitabine/ Efavirenz: An Open-Label, Randomized Controlled Trial

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