The Effect of HIV-Hepatitis C Co-Infection on Bone Mineral Density and Fracture: A Meta-Analysis

Abstract

ObjectiveThere is a variable body of evidence on adverse bone outcomes in HIV patients co-infected with hepatitis C virus (HCV). We examined the association of HIV/HCV co-infection on osteoporosis or osteopenia (reduced bone mineral density; BMD) and fracture.DesignSystematic review and random effects meta-analyses.MethodsA systematic literature search was conducted for articles published in English up to 1 April 2013. All studies reporting either BMD (g/cm2, or as a T-score) or incident fractures in HIV/HCV co-infected patients compared to either HIV mono-infected or HIV/HCV uninfected/seronegative controls were included. Random effects meta-analyses estimated the pooled odds ratio (OR) and the relative risk (RR) and associated 95% confidence intervals (CI).ResultsThirteen eligible publications (BMD N = 6; Fracture = 7) of 2,064 identified were included with a total of 427,352 subjects. No publications reported data on HCV mono-infected controls. Meta-analysis of cross-sectional studies confirmed that low bone mineral density was increasingly prevalent among co-infected patients compared to HIV mono-infected controls (pooled OR 1.98, 95% CI 1.18, 3.31) but not those uninfected (pooled OR 1.47, 95% CI 0.78, 2.78). Significant association between co-infection and fracture was found compared to HIV mono-infected from cohort and case-control studies (pooled RR 1.57, 95% CI 1.33, 1.86) and compared to HIV/HCV uninfected from cohort (pooled RR 2.46, 95% CI 1.03, 3.88) and cross-sectional studies (pooled OR 2.30, 95% CI 2.09, 2.23).ConclusionsThe associations of co-infection with prevalent low BMD and risk of fracture are confirmed in this meta-analysis. Although the mechanisms of HIV/HCV co-infection’s effect on BMD and fracture are not well understood, there is evidence to suggest that adverse outcomes among HIV/HCV co-infected patients are substantial.

Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

“…Coinfection with hepatitis B and C was low. Two recent reviews have shown that the prevalence of low BMD and the risk of fracture are higher in hepatitis C-HIV coinfected patients than in HIV mono-infected controls [14,15], reflecting probably additional risk factors of osteoporosis associated with hepatitis C infection. Despite the exclusion of men treated for osteoporosis, optimization of vitamin D levels and low rate of coinfection with hepatitis B and C, we detected lower total vBMD at distal radius and tibia (16 and 14.3%, respectively) in HIV-positive men.…”

Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture

“…The incidences of liver- and non-liver-related complications of chronic HCV infection are higher among HIV/HCV co-infected patients than HCV mono-infected patients [11,12]. In addition to its ability to induce liver fibrosis, chronic HCV infection is also associated with extra-hepatic complications, particularly abnormalities in bone metabolism and increased fracture risk, that may contribute to morbidity among HIV/HCV co-infected patients as this group ages [2,6,13,14]. …”

Bone Loss in HIV Infection

“…Traditional risk factors for low BMD, including low body mass index (BMI), smoking, hypogonadism or menopause, and corticosteroid use are highly prevalent among HIV-infected individuals [12, 26–29]. However, individuals with HIV experience BMD loss beyond what would be expected from these traditional risk factors alone [30], and there is evidence that both the HIV virus itself, and treatment with cART, contribute to ongoing bone loss in the HIV population.…”