Revista de SIDA e investigación clínica

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients

Abstract

Valentina Li Vecchi, Maurizio Soresi, Lydia Giannitrapani, Giovanni Mazzola, Pietro Colletti, Ilaria Domenica Amico, Fabio Tramuto, Walter Grana, Massimo Midiri, Giuseppe Caruso, Giuseppe Montalto and Paola Di Carlo

Objective: We assessed the prevalence and risk factors of decreased bone mineral density (BMD) in patients mono-infected with human immunodeficiency virus (HIV) or co-infected with hepatitis C virus (HIV/HCV). We also evaluated whether bone loss was linked to lipid asset in both groups and to severity of liver fibrosis in the co-infected group.

Methods: We consecutively enrolled 194 HIV-patients (129 mono-infected and 65 co-infected). All HIV-patients underwent dual-energy X-ray absorptiometry (DXA), while co-infected patients underwent transient elastography. Advanced liver fibrosis was defined as a median liver stiffness ≥ 9.5 kPa. Fibrosis was also assessed in all the HIVpatients using FIB-4.

Results: The overall prevalence of low BMD and osteoporosis was 26.8% and 26.0%, respectively. It was significantly higher among HIV/HCV co-infected than mono-infected patients in lumbar/femoral sites (P<0.04 and P<0.05, respectively). HDL-cholesterol levels correlated independently with lumbar DXA Z-score (P<0.03) in HIV mono-infected subjects. Liver stiffness correlated negatively and independently with femoral Z- and T-scores among co-infected patients (P<0.003; P<0.01, respectively). Stratifying co-infected subjects by sex, liver stiffness and lumbar/ femoral Z-scores (P<0.04) or T-scores (P<0.05; P<0.04, respectively) correlated negatively only in the females. Longer PI exposure was negatively and independently correlated with BMD.

Conclusion: Our HIV-infected patients appeared at high risk for low BMD and osteoporosis. Severity of liver fibrosis was an independent predictor of bone loss in co-infection, although other factors could affect the skeletal system in HIV/HCV co-infection. Further research into the impact of liver fibrosis and lipid asset on bone disease in HIV-infection is necessary