Dong Huan V, Cortés Yamnia I, Shiau Stephanie, Yin Michael T
AIDS. 2014 Sep 10;28(14):2119-31. doi: 10.1097/QAD.0000000000000363.
There is growing evidence that fracture risk is increased in individuals with HIV and/or hepatitis C virus (HCV) infection. We systematically reviewed the literature to determine whether prevalence of osteoporosis and incidence of fracture is increased in HIV/HCV-coinfected individuals.
A systematic review and meta-analysis.
A search was performed of Medline, Scopus and the Cochrane Library databases, as well as of abstracts from annual retroviral, liver and bone meetings (up to 2013) for studies with bone mineral density (BMD) or bone fracture data for HIV/ HCV-coinfected individuals. Osteoporosis odds ratios (ORs) and fracture incidence rate ratios (IRRs) were estimated from studies with data on HIV-monoinfected or HIV/HCV uninfected comparison groups.
Of 15 included studies, nine reported BMD data and six reported fracture data. For HIV/HCV-coinfected, the estimated osteoporosis prevalence was 22% [95% confidence interval (95% CI) 12–31] and the crude OR for osteoporosis compared with HIV-monoinfected was 1.63 (95% CI 1.27-2.11). The pooled IRR of overall fracture risk for HIV/HCV-coinfected individuals was 1.77 (95% CI 1.44-2.18) compared with HIV-monoinfected and 2.95 (95% CI 2.17-4.01) compared with uninfected individuals. In addition to HIV/HCV-coinfection, older age, lower BMI, smoking, alcohol and substance use were significant predictors of osteoporosis and fractures across studies.
HIV/HCV coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection; fracture risk is even greater than uninfected controls. These data suggest that HIV/HCV-coinfected individuals should be targeted for fracture prevention through risk factor modification at all ages and DXA screening at age 50.
越来越多的证据表明，感染人类免疫缺陷病毒（HIV）和/或丙型肝炎病毒（HCV）的个体骨折风险增加。我们系统回顾了文献，以确定HIV/HCV合并感染个体的骨质疏松症患病率和骨折发生率是否增加。
系统回顾和荟萃分析。
检索了Medline、Scopus和Cochrane图书馆数据库，以及年度逆转录病毒、肝脏和骨骼会议（截至2013年）的摘要，以获取有关HIV/HCV合并感染个体骨密度（BMD）或骨折数据的研究。骨质疏松症优势比（OR）和骨折发生率比（IRR）是根据有HIV单一感染或未感染HIV/HCV的对照组数据的研究估算得出的。
在纳入的15项研究中，9项报告了BMD数据，6项报告了骨折数据。对于HIV/HCV合并感染个体，估计的骨质疏松症患病率为22%[95%置信区间（95%CI）12 - 31]，与HIV单一感染个体相比，骨质疏松症的粗OR为1.63（95%CI 1.27 - 2.11）。与HIV单一感染个体相比，HIV/HCV合并感染个体总体骨折风险的合并IRR为1.77（95%CI 1.44 - 2.18），与未感染个体相比为2.95（95%CI 2.17 - 4.01）。除了HIV/HCV合并感染外，年龄较大、体重指数较低、吸烟、饮酒和药物使用在各项研究中都是骨质疏松症和骨折的重要预测因素。
与HIV单一感染相比，HIV/HCV合并感染与更高的骨质疏松症和骨折风险相关；骨折风险甚至高于未感染对照组。这些数据表明，应针对所有年龄段的HIV/HCV合并感染个体通过改变危险因素进行骨折预防，并在50岁时进行双能X线吸收法（DXA）筛查。
