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Risk of Fractures Associated with HIV/Hepatitis C Coinfection
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Reported by jules Levin
CROI 2011
CROI: Bone and Vitamin D at CROI 2011 - By Todd T. Brown, MD, PhD - (03/26/11)
CROI: Bone & HIV CROI 2011 - (03/26/11)
CROI: Changes in Body Composition and Bone after Switching from Ritonavir-Boosted Protease Inhibitors to Raltegravir in Virologically Suppressed HIV-1-Infected Patients (SPIRAL-LIP substudy) - (03/26/11)
J. Volk,1 R. Localio,2 C. Newcomb,2 Y. Yang,2 S. Hennessy,2 J Kostman,2 P. Tebas,2 M. Leonard,2 V. Lo Re III2
1Massachusetts General Hospital and 2University of Pennsylvania
Funding Sources: Penn CFAR Developmental Grant (P30-AI045008); NIH K01-AI070001 (Lo Re)
ABSTRACT
Background: HIV and HCV infections are both associated with reduced bone mineral density, but associations with fractures have not been examined. Our objective was to determine if ART-treated HIV/HCV patients have an increased risk for fractures compared to: 1) HCV monoinfected, 2) HIV monoinfected on ART, and 3) HIV/HCV uninfected patients.
Methods: We performed a retrospective cohort study among U.S. Medicaid patients from CA, OH, FL, NY, and PA aged 18 years or older between 1999 and 2005. HIV, HCV, and hip and vertebral spine fractures were determined by previously validated ICD-9 codes. ART use was determined from pharmacy claims. Propensity scores were developed to balance covariates between cohorts being compared. Adjusted hazard ratios (HRs) of incident fractures during follow-up were estimated using Cox regression.
Results: Among 36,950 HIV/HCV coinfected, 276,901 HCV monoinfected, 95,827 HIV monoinfected, and 366,829 uninfected patients, HIV/HCV coinfection was associated with an increased relative hazard of hip fracture compared to HCV monoinfected patients and an increased hazard ratio of both hip and spine fractures compared to HIV monoinfected and uninfected persons (see Table at right).
Conclusions: HIV/HCV coinfected patients are at an increased risk for hip fracture compared to HCV monoinfected patients and are at higher risk for hip and spine fractures compared to HIV monoinfected and HIV/HCV uninfected persons.
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