Department of Medicine, Veterans Affairs North Texas Health Care System and the University of Texas Southwestern Medical Center at Dallas.
Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas.
Clin Infect Dis. 2018 Apr 17;66(9):1442-1447. doi: 10.1093/cid/cix1011.
Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected individuals have a significantly greater osteoporotic fracture risk than HIV-monoinfected persons, despite the fact that HIV/HCV coinfection has not been associated with lower bone mineral density (BMD) than HIV or HCV alone. To evaluate if changes in bone microarchitecture, measured by trabecular bone score (TBS), could explain these differences, we performed a prospective, cross-sectional cohort study of virologically suppressed HIV-infected subjects, untreated HCV-infected subjects, HIV/HCV-coinfected subjects, and uninfected controls.
We enrolled 532 male subjects: 57 HIV/HCV coinfected, 174 HIV infected, 123 HCV infected, and 178 controls. We conducted analysis of covariance comparing BMD and TBS between groups, controlling for age, race, body mass index, and smoking. We used linear regression to evaluate predictors of BMD and TBS and evaluated the effects of severity of HCV infection and tenofovir disoproxil fumarate use.
Despite both infections being associated with decreased BMD, only HCV, but not HIV, was associated with lower TBS score. Also, HIV/HCV-coinfected subjects had lower TBS scores than HIV-monoinfected, HCV-monoinfected, and uninfected subjects. Neither the use of TDF or HCV viremia nor the severity of HCV liver disease was associated with lower TBS.
HCV infection is associated with microarchitectural changes at the lumbar spine as assessed by the low TBS score, suggesting that microstructural abnormalities underlie some of the higher fracture risk in HCV infection. TBS might improve fracture risk prediction in HCV infection.
与 HIV 单一感染相比，HIV/HCV 合并感染个体的骨质疏松性骨折风险显著增加，尽管 HIV/HCV 合并感染与 HIV 或 HCV 单一感染相比并未导致更低的骨密度（BMD）。为了评估通过小梁骨评分（TBS）测量的骨微结构变化是否可以解释这些差异，我们对病毒学抑制的 HIV 感染受试者、未治疗的 HCV 感染受试者、HIV/HCV 合并感染受试者和未感染对照进行了一项前瞻性、横断面队列研究。
我们招募了 532 名男性受试者：57 名 HIV/HCV 合并感染、174 名 HIV 感染、123 名 HCV 感染和 178 名对照。我们通过协方差分析比较了各组之间的 BMD 和 TBS，控制了年龄、种族、体重指数和吸烟因素。我们使用线性回归来评估 BMD 和 TBS 的预测因素，并评估了 HCV 感染严重程度和替诺福韦二吡呋酯使用的影响。
尽管两种感染都与 BMD 降低有关，但只有 HCV，而不是 HIV，与较低的 TBS 评分有关。此外，与 HIV 单一感染、HCV 单一感染和未感染受试者相比，HIV/HCV 合并感染受试者的 TBS 评分更低。TDF 的使用或 HCV 病毒血症以及 HCV 肝病的严重程度均与较低的 TBS 评分无关。
HCV 感染与腰椎的微结构变化有关，TBS 评分较低提示微结构异常是 HCV 感染骨折风险增加的部分原因。TBS 可能会提高 HCV 感染的骨折风险预测。
