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  ID Week
Oct 8-12 2014
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Hip Fracture Rate Higher With HIV/HBV Than HIV Alone in Medicaid Analysis
  IDWeek 2014, October 8-12, 2014, Philadelphia
IDSA: Increased Risk of Hip Fracture Associated with Dually-Treated HIV/Hepatitis B Virus Coinfection - (10/15/14)
IDSA: Structural Bone Deficits in HIV/HCV, HCV-Monoinfected, and HIV-Monoinfected Women - (10/14/14)
Mark Mascolini
Medicaid recipients treated for HIV and HBV infection had higher hip fracture incidence than people taking antiretroviral therapy (ART) for HIV infection or people with neither HIV nor HBV [1]. For every 1000 people, those treated for HIV and HBV had 4 additional hip fractures in 5 years than those treated only for HIV or only for HBV.
Both HIV and HBV infection have been linked to decreased bone mineral density, probably partly because of HIV- and HBV-associated inflammation inhibiting bone formation and increasing bone resorption, and partly because of behavioral and disease-related cofactors common in people with HIV or HBV. Because no studies have assessed fracture risk in people with HIV/HBV coinfection, University of Pennsylvania researchers conducted this large analysis of people in the Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania during 1999-2007.
This retrospective analysis aimed to determine time to incident hip fracture risk with dually treated HIV/HBV infection versus (1) treated HBV monoinfection, (2) treated HIV monoinfection, and (3) neither infection. The researchers matched the coinfected cohort to comparison cohorts according to propensity scores reflecting relevant variables. Weighted survival models accounting for competing risks estimated cumulative incidence and hazard ratios for incident hip fracture in the HIV/HBV group versus the three comparison groups.
The three comparisons included (1) 1007 dually treated HIV/HBV patients and 1007 treated HBV patients, (2) 4155 dually treated HIV/HBV patients and 16,579 treated HIV patients, and (3) 4150 dually treated HIV/HBV patients and 16,522 uninfected people. Cumulative hip fracture incidence at 5 years was always higher in the dually treated HIV/HBV group:
-- HIV/HBV 0.70% versus HBV alone 0.27% (not significant)
-- HIV/HBV 1.70% versus HIV alone 1.24% (significant)
-- HIV/HBV 1.48% versus neither HIV nor HBV 0.83% (significant)
In an analysis accounting for tenofovir use, at 5 years dually treated HIV/HBV patients had a 37% higher hip fracture risk than ART-treated HIV patients (adjusted hazard ratio [aHR] 1.37, 95% confidence interval [CI] 1.03 to 1.83). And at 5 years dually treated HIV/HBV patients had an 83% higher fracture risk than uninfected people (aHR 1.83, 95% CI 1.33 to 2.51). In the comparison of HIV/HBV patients with HBV-monoinfected patients, fracture risk was greater with coinfection but not significantly so (aHR 2.62, 95% CI 0.92 to 7.51).
The researchers calculated that HIV/HBV-coinfected people had 4 or more hip fractures per 1000 people than each of the comparison groups at 5 years:
-- HIV/HBV versus HBV alone: 4.3 additional hip fractures
-- HIV/HBV versus HIV alone: 4.6 additional hip fractures
-- HIV/HBV versus uninfected: 6.6 additional hip fractures
The researchers concluded that among Medicaid enrollees hip fracture risk is significantly higher with dually treated HIV/HBV infection than with antiretroviral-treated HIV infection or neither infection. They proposed that future studies "examine mechanisms for bone disease as well as intervention and therapies to prevent fractures among coinfected patients."
1. Lo Re III V, Byrne D, Newcomb C, et al. Increased risk of hip fracture associated with dually-treated HIV/hepatitis B virus coinfection. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1603.