Liver disease severity and low bone mineral density in HIV mono-infected and HIV/HCV co-infected patients

Background: In this study we assess: prevalence of osteopenia, osteoporosis and reduced bone mineral density in HIV infection and HIV / HCV co-infection;risk factors associated with reduced bone mineral density(BMD); relationship between bone mineral density and reduced liver fibrosis (FE) measured as "liver stiffness" (LS), by FibroScan ® in patients co-infected with HIV / HCV; relationship between reduced bone mineral density and cardiovascular risk assessed with the 10-year Framingham risk score (FRS) in HIV / HCV co-infected Patients And Methods: One hundred and ninety-four HIV-infected subjects (121 males =62% and 73 females = 38 %): 129 HIV-infected ( 66.5 % ) and 65 HIV / HCV co-infected (33.5 %) were consecutively enrolled. The median age was 48, 89/194 (45.9 %) patients were older than 50 years HIV-RNA, CD4+ T-cell count and data on antiretroviral therapy were also recorded. Both biochemical bone turnover markers and BMD, assessed by dual-energy X-ray absorptiometry (DEXA) were recorded in the HIV-cases and controls. The subjects underwent liver ultrasonography and transient elastography using Fibroscan. Results: The prevalence of reduced bone mineral density and osteoporosis was significantly higher in HIV / HCV co-infected compared to HIV mono-infected (P <0.04 and P <0.05, respectively). HIV/HCV co-infected patients: The values of bone alkaline phosphatase negatively correlated with DEXA Z-score lumbar and femoral (P <0.05, P <0.02). The Z-score femoral artery was negatively correlated with the score of PI exposure (P <0.02). BMI was positively correlated with the femoral DEXA Z-score (P <0.05). The LS was negatively correlated with the femoral DEXA Z-score (P <0.01), the FIB-4 was negatively correlated with DEXA Z-score lumbar and femoral (P <0.01). When we analyzed the correlation of LS with DEXA Z-score in relation to sex, it showed a significant correlation between bone loss and severity of fibrosis only in females [lumbar Z-score -0.5 (p <0.04) (Figure 1) , femoral Z-score -0.5 (p <0.04)].Multiple logistic regression: among all the variables found to be significant on univariate analysis, BMI was positively correlated with DEXA Z-score lumbar and femoral artery in HIV-mono-infected (β = 0.3, P <0.01, β = 0:45, P <0.0001). The Col-HDL was independently correlated positively with lumbar DEXA Z-score (β = 0.2, P <0.02). In patients with HIV / HCV co-infected the BMI was positively correlated with the femoral DEXA Z-score (β = 0:45, P <0.0001). The LS was an independent predictor of bone loss at the femoral DEXA Z-score (β = -0.43, P <0.003). The FIB-4 was negatively correlated with lumbar DEXA Z-score (β = -0.43, P <0.004).Conclusions:The prevalence of reduced bone mineral density / osteoporosis was significantly higher in HIV/HCV co-infected patients compared to HIV- infected . When patients were stratified according to sex , the LS was an independent predictor of bone loss only in HIV / HCV co- infected females . These data suggest that viral hepatitis increases the risk of bone loss in females with HIV infect! ion but not in males. A higher BMI and higher Col-HDL values were protective predictors of bone mineral density .