Program Schedule

Structural Bone Deficits in HIV/HCV, HCV-Monoinfected, and HIV-Monoinfected Women

Session: Oral Abstract Session: HIV Related Inflammation, Complications and Comorbidities
Friday, October 10, 2014: 11:30 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. However, the structural underpinnings for the skeletal fragility in coinfected women have not been characterized. We used peripheral quantitative computed tomography (pQCT) and whole-body dual X-ray absorptiometry (DXA) to evaluate musculoskeletal parameters in HIV/HCV women.

Methods: We conducted a cross-sectional study in 50 antiretroviral therapy (ART)-treated HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 ART-treated HIV-monoinfected women. Tibial trabecular and cortical volumetric BMD (vBMD) and cortical dimensions were determined by pQCT. Whole-body fat mass and appendicular lean mass were measured by DXA. Age- and race-specific Z-scores were generated using data from 263 women without HIV or liver disease recruited as a reference group. Linear regression was used to evaluate differences in mean pQCT Z-scores between HIV/HCV and comparator groups, adjusted for fat and lean mass Z-scores.

Results: Coinfected participants had lower mean trabecular Z-scores for vBMD (-0.85), cortical vBMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) compared to the reference group (p<0.001), which remained after adjustment for fat and lean mass. The decreased cortical dimensions were due to greater mean endosteal circumference (0.67; p<0.001), with comparable periosteal circumference (0.04), Z-scores. Coinfected patients had lower mean trabecular vBMD Z-scores than HCV-monoinfected (-0.85 vs. -0.21; p=0.004) and HIV-monoinfected (-0.85 vs. 0.06; p<0.001) participants. Among all chronic HCV patients (n=101), those with stage 3 or 4 liver fibrosis (advanced fibrosis/cirrhosis) had lower trabecular vBMD (-0.90 vs. -0.44; p=0.04) and cortical thickness (-1.1 vs. -0.36; p=0.02) Z-scores than those with stage 0-2 fibrosis.

Conclusion: ART-treated HIV/HCV-coinfected women had lower tibial trabecular vBMD, diminished cortical dimensions, and significant endocortical bone loss compared to healthy reference participants. Tibial trabecular vBMD was also lower in coinfected than HCV- and HIV-monoinfected women. Future studies should evaluate the mechanisms for these structural abnormalities and explore if successful HCV therapy can reverse bone loss in HIV/HCV patients.

Vincent Lo Re III, MD, MSCE1, Kenneth Lynn, RN1, Emily Stumm, BS1, Jin Long, PhD2, Melissa Nezamzadeh, BA1, Joshua Baker, MD1, Angela Kapalko, MHS, PA3, Karam Mounzer, MD3, Pablo Tebas, MD1, Jay Kostman, MD1 and Mary Leonard, MD, MSCE2, (1)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (2)Children's Hospital of Philadelphia, Philadelphia, PA, (3)Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA


V. Lo Re III, None

K. Lynn, None

E. Stumm, None

J. Long, None

M. Nezamzadeh, None

J. Baker, None

A. Kapalko, None

K. Mounzer, None

P. Tebas, None

J. Kostman, None

M. Leonard, None

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