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Chronic viral hepatitis is associated with low bone mineral density in HIV-infected patients, ANRS CO 3 Aquitaine Cohort
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Osteopenia was present in 320 patients (51.1%) and osteoporosis in 187 (29.9%).....we documented high prevalence rates of osteoporosis, considering the average age.....the frequency of osteoporosis was higher in HIV-infected patients with chronic viral hepatitis than among HIV-mono-infected ones ......Older age and low BMI were associated with osteoporosis in both women and men......bone mass loss was also higher in MSM patients than in any other patients as previously reported..... The association between chronic viral hepatitis B or C and osteoporosis was found in women only (OR: 19.0; p-value: 0.047).
JAIDS Journal of Acquired Immune Deficiency Syndromes: POST ACCEPTANCE, 4 January 2013
Lawson-Ayayi, S PharmD, PhD; Cazanave, C MD, PhD; Kpozehouen, A PhD; Barthe, N PharmD; Mehsen, N MD; Hessamfar, M. MD, PhD; Dupon, M MD; Dabis, F MD, PhD; Neau, D MD, PhD; for the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)
Published Ahead-of-Print
Abstract
Background: High prevalence rates of low bone mineral density (BMD) have been reported in people living with human immunodeficiency virus (HIV) infection. We aimed to investigate the association of chronic viral hepatitis with low BMD in HIV-infected patients.
Methods: A hospital-based cohort of HIV-infected patients was screened for hepatitis B and C co-infection. BMD was measured by dual energy X-ray absorptiometry (DXA). T-score was used to define bone status according to WHO classification; moreover each observed BMD value was compared with reference to an average person of same age and gender as a Z-score <-2.0 allow diagnosis of patients having less bone mass and/or losing bone material more rapidly than expected. A polytomial logistic regression was performed by gender to investigate the association between chronic viral hepatitis and low BMD (osteopenia and osteoporosis) in HIV-infected patients.
Results: A total of 626 patients (166 females of whom 52 postmenopausal) were recruited: 357 HIV-mono-infected, and 269 HIV-co-infected with chronic viral hepatitis, among whom 61 with a diagnosis of cirrhosis. Osteopenia was present in 320 patients (51.1%) and osteoporosis in 187 (29.9%). After adjustment, osteoporosis was associated with older age and low BMI in both genders. The association between chronic viral hepatitis B or C and osteoporosis was found in women only (OR: 19.0; p-value: 0.047).
Conclusion: We found a high prevalence of low BMD overall but chronic viral hepatitis was independently associated with osteoporosis only in female participants. Our data confirm the need of BMD evaluations for patients living with HIV.
Excerpts:
"Osteopenia was diagnosed in 320 patients (51.1%) without any difference according to hepatitis co-infection status and osteoporosis in 187 (29.9%) (Table 1). Osteoporosis was present in 34.6% of co-infected patients and 26.3% of HIV-infected patients without chronic viral hepatitis (p=0.032). Osteoporosis appeared to be less frequently observed in co-infected patients without cirrhosis (69/208, 33.2%) than in cirrhotic ones (24/61, 39.3%) (p=0.054)."
"Polytomial logistic regression investigated patients' determinants of osteopenia and osteoporosis, and results are reported by gender in Tables 3 and 4. After adjustment, the final model showed that, for both male and female patients, levels of low BMD were significantly associated with older age and BMI <20 kg/m. Osteopenia and osteoporosis were also particularly frequent among men who had reported sex with men (MSM): 52.6% and 38.3%, respectively. The association between chronic viral hepatitis and osteoporosis was only present in women (OR=19.0, p=0.0474). Among both genders, the multivariable analysis failed to identify any association between cirrhosis and either osteopenia or osteoporosis. ART and exposure duration to each antiretroviral class were not predictive of low BMD (data not shown)."
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