title: Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Compared with healthy reference patients, HIV/HCV-coinfected women had decreased tibial trabecular volumetric BMD, diminished cortical dimensions, and significant endocortical bone loss.
authors.affiliation: Division of Infectious Diseases Division of Center for AIDS Research Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.affiliation: Division of Infectious Diseases Division of Center for AIDS Research.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lynn
authors.affiliation: Division of Infectious Diseases Division of Center for AIDS Research.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Stumm
authors.affiliation: Healthcare Analytics Unit, Children's Hospital of Philadelphia.
authors.forename: Jin
authors.initials: J
authors.lastname: Long
authors.affiliation: Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Nezamzadeh
authors.affiliation: Division of Rheumatology, Department of Medicine.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Hoofnagle
authors.affiliation: Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Kapalko
authors.affiliation: Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania.
authors.forename: Karam
authors.initials: K
authors.lastname: Mounzer
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia.
authors.forename: Babette S
authors.initials: BS
authors.lastname: Zemel
authors.affiliation: Division of Infectious Diseases Division of Center for AIDS Research.
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
authors.affiliation: Division of Infectious Diseases Division of Center for AIDS Research.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Kostman
authors.affiliation: Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology Department of Pediatrics and Medicine, Stanford University, California.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
mesh_terms: D000328:Adult; D015519:Bone Density; D060085:Coinfection / Q000150:complications* / Q000821:virology; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000235:genetics / Q000378:metabolism; D005260:Female; D005786:Gene Expression Regulation; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D014807:Vitamin D / Q000378:metabolism
chemical_list: D016207:Cytokines; D014807:Vitamin D
keywords: HIV; bone; coinfection; hepatitis C virus; peripheral quantitative computed tomography