Lo Re Vincent, Lynn Kenneth, Stumm Emily R, Long Jin, Nezamzadeh Melissa S, Baker Joshua F, Hoofnagle Andrew N, Kapalko Angela J, Mounzer Karam, Zemel Babette S, Tebas Pablo, Kostman Jay R, Leonard Mary B
Division of Infectious Diseases Division of Center for AIDS Research Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology.
Division of Infectious Diseases Division of Center for AIDS Research.
J Infect Dis. 2015 Sep 15;212(6):924-33. doi: 10.1093/infdis/jiv147. Epub 2015 Mar 9.
Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibial peripheral quantitative computed tomography to evaluate skeletal parameters in women, by HIV/HCV status.
We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined with peripheral quantitative computed tomography. Race-specific z scores for age were generated using 263 female reference participants without HIV infection or liver disease.
Coinfected participants had lower mean z scores for trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) than reference participants (all P < .001). The smaller cortical dimensions were due to greater mean z scores for endosteal circumference (+0.67; P < .001) and comparable z scores for periosteal circumference (+0.04; P = .87). Trabecular volumetric BMD was lower in coinfected than in HCV- or HIV-monoinfected participants. HCV-infected women with stage 3-4 liver fibrosis had lower mean z scores for trabecular volumetric BMD, cortical thickness, and total hip BMD those with stage 0-2 fibrosis.
Compared with healthy reference patients, HIV/HCV-coinfected women had decreased tibial trabecular volumetric BMD, diminished cortical dimensions, and significant endocortical bone loss.
人类免疫缺陷病毒（HIV）与丙型肝炎病毒（HCV）合并感染与骨矿物质密度（BMD）降低及骨折率增加有关，尤其是在女性中。合并感染女性骨骼脆弱的结构基础尚未明确。我们使用胫骨外周定量计算机断层扫描，按HIV/HCV感染状况评估女性的骨骼参数。
我们对50名HIV/HCV合并感染、51名单纯HCV感染和50名单纯HIV感染的女性进行了一项横断面研究。使用外周定量计算机断层扫描测定胫骨体积骨密度和皮质尺寸。利用263名无HIV感染或肝病的女性参考参与者生成年龄特异性种族z评分。
与参考参与者相比，合并感染参与者的小梁体积骨密度（-0.85）、皮质体积骨密度（-0.67）、皮质面积（-0.61）和皮质厚度（-0.77）的平均z评分较低（所有P <.001）。皮质尺寸较小是由于骨内膜周长的平均z评分较高（+0.67；P <.001），而骨膜周长的z评分相当（+0.04；P = 0.87）。合并感染患者的小梁体积骨密度低于单纯HCV感染或单纯HIV感染的参与者。3-4期肝纤维化的HCV感染女性的小梁体积骨密度、皮质厚度和全髋骨密度的平均z评分低于0-2期纤维化的女性。
与健康参考患者相比，HIV/HCV合并感染的女性胫骨小梁体积骨密度降低,皮质尺寸减小，且有明显的骨内膜骨质流失。
