Byrne D D, Newcomb C W, Carbonari D M, Nezamzadeh M S, Leidl K B F, Herlim M, Yang Y X, Hennessy S, Kostman J R, Leonard M B, Localio A R, Lo Re V
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Viral Hepat. 2015 Nov;22(11):936-47. doi: 10.1111/jvh.12398. Epub 2015 Mar 6.
HIV and hepatitis B virus (HBV) infections are each associated with reduced bone mineral density, but it is unclear whether HIV/HBV coinfection is associated with an increased risk of fracture. We determined whether dually treated HIV/HBV patients had a higher incidence of hip fracture compared to treated HBV-monoinfected, antiretroviral therapy (ART)-treated HIV-monoinfected and HIV/HBV-uninfected patients. We conducted a cohort study among 4156 dually treated HIV/HBV-coinfected, 2053 treated HBV-monoinfected, 96,253 ART-treated HIV-monoinfected, and 746,794 randomly sampled uninfected persons within the US Medicaid populations of California, Florida, New York, Ohio and Pennsylvania (1999-2007). Coinfected patients were matched on propensity score to persons in each comparator cohort. Weighted survival models accounting for competing risks were used to estimate cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs) of incident hip fracture for dually treated coinfected patients compared to (i) HBV-monoinfected receiving nucleos(t)ide analogue or interferon alfa therapy, (ii) HIV-monoinfected on ART and (iii) uninfected persons. Dually treated coinfected patients had a higher cumulative incidence of hip fracture compared to ART-treated HIV-monoinfected (at 5 years: 1.70% vs 1.24%; adjusted HR, 1.37 [95% CI, 1.03-1.83]) and uninfected (at 5 years: 1.64% vs 1.22%; adjusted HR, 1.35 [95% CI, 1.03-1.84]) persons. The cumulative incidence of hip fracture was higher among coinfected than treated HBV-monoinfected patients (at 5 years: 0.70% vs 0.27%), but this difference was not statistically significant in competing risk analysis (adjusted HR, 2.62 [95% CI, 0.92-7.51]). Among Medicaid enrollees, the risk of hip fracture was higher among dually treated HIV/HBV-coinfected patients than ART-treated HIV-monoinfected and uninfected persons.
艾滋病毒（HIV）感染和乙型肝炎病毒（HBV）感染均与骨矿物质密度降低有关，但尚不清楚HIV/HBV合并感染是否会增加骨折风险。我们比较了接受联合治疗的HIV/HBV合并感染患者与接受治疗的单纯HBV感染患者、接受抗逆转录病毒治疗（ART）的单纯HIV感染患者以及未感染HIV/HBV的患者相比，髋部骨折的发生率是否更高。我们在加利福尼亚州、佛罗里达州、纽约州、俄亥俄州和宾夕法尼亚州的美国医疗补助人群中（1999 - 2007年），对4156例接受联合治疗的HIV/HBV合并感染患者、2053例接受治疗的单纯HBV感染患者、96253例接受ART治疗的单纯HIV感染患者以及746794例随机抽样的未感染患者进行了队列研究。合并感染患者根据倾向评分与每个对照队列中的患者进行匹配。使用考虑竞争风险的加权生存模型来估计联合治疗的合并感染患者与（i）接受核苷（酸）类似物或干扰素α治疗的单纯HBV感染患者、（ii）接受ART治疗的单纯HIV感染患者以及（iii）未感染患者相比，髋部骨折的累积发病率和风险比（HRs）及其95%置信区间（CIs）。与接受ART治疗的单纯HIV感染患者（5年时：1.70%对1.24%；调整后HR，1.37 [95% CI，1.03 - 1.83]）和未感染患者（5年时：1.64%对1.22%；调整后HR，1.35 [95% CI，1.03 - 1.84]）相比，接受联合治疗的合并感染患者髋部骨折的累积发病率更高。合并感染患者的髋部骨折累积发病率高于接受治疗的单纯HBV感染患者（5年时：0.70%对0.27%），但在竞争风险分析中，这种差异无统计学意义（调整后HR，2.62 [95% CI，0.92 - 7.51]）。在医疗补助参保者中，接受联合治疗的HIV/HBV合并感染患者髋部骨折的风险高于接受ART治疗的单纯HIV感染患者和未感染患者。
