title: Controlled HIV viral replication, not liver disease severity associated with low bone mineral density in HIV/HCV co-infection.
abstract: OBJECTIVE
  To evaluate the prevalence and risk factors for low bone mineral density (BMD) in persons co-infected with HIV and Hepatitis C.
  
  
  METHODS
  HIV/HCV co-infected study participants (n=179) were recruited into a prospective cohort and underwent dual-energy X-ray absorptiometry (DXA) within 1 year of a liver biopsy. Fibrosis staging was evaluated according to the METAVIR system. Osteoporosis was defined as a T-score ≤-2.5. Z-scores at the total hip, femoral neck, and lumbar spine were used as the primary outcome variables to assess the association between degree of liver disease, HIV-related variables, and BMD.
  
  
  RESULTS
  The population was 65% male, 85% Black with mean age 50.3 years. The prevalence of osteoporosis either at the total hip, femoral neck, or lumbar spine was 28%, with 5% having osteoporosis of the total hip, 6% at the femoral neck, 25% at the spine. The mean Z-scores (standard deviation) were -0.42 (1.01) at the total hip, -0.16 (1.05) at the femoral neck, and -0.82 (1.55) at the lumbar spine. In multivariable models, controlled HIV replication (HIV RNA <400 copies/ml vs. ≥400 copies/ml) was associated with lower Z-scores (mean ± standard error) at the total hip (-0.44 ± 0.17, p = 0.01), femoral neck (-0.59 ± 0.18, p = 0.001), and the spine (-0.98 ± 0.27, p = 0.0005). There was no association between degree of liver fibrosis and Z-score.
  
  
  CONCLUSIONS
  Osteoporosis was very common in this population of predominately African-American HIV/HCV co-infected patients, particularly at the spine. Lower BMD was associated with controlled HIV replication, but not liver disease severity.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Diala
authors.initials: D
authors.lastname: El-Maouche
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Catherine
authors.initials: C
authors.lastname: Sutcliffe
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Higgins
authors.forename: Michael S
authors.initials: MS
authors.lastname: Torbenson
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sulkowski
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000453:epidemiology; D045744:Cell Line, Tumor; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014779:Virus Replication / Q000502:physiology*