Bedimo RJ, et al. - Despite no association of HIV/HCV co-infection with lower bone mineral density (BMD) compared to HIV or HCV alone, HIV/HCV co-infected subjects have a significantly higher osteoporotic fracture risk than HIV-infected. Researchers here aimed to assess if changes in bone microarchitecture, measured by trabecular bone score (TBS) could explain these differences. They observed an association of HCV infection with micro-architectural 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. An improvement in fracture risk prediction could be achieved with TBS in HCV infection.

Methods

• A prospective, cross-sectional cohort study of virologically suppressed HIV, untreated HCV, HIV/HCV co-infected and non-infected controls was performed.
• Five-hundred-thirty-two male subjects were enrolled : 57 HIV/HCV, 174 HIV, 123 HCV and 178 controls.
• Analysis of covariance comparing BMD and TBS between groups was performed, controlling for age, race, BMI and smoking.
• Linear regression was used to assess predictors of BMD and TBS.
• The effects of severity of HCV infection and Tenofovir (TDF) use were determined.

Results

• Although both infections were associated with decreased BMD, only HCV, but not HIV was associated with lower TBS score.
• HIV/HCV co-infected subjects indicated lower TBS scores in comparison to HIV mono-infected, HCV mono-infected and uninfected subjects.
• Lower TBS seemed to have no association with the use of TDF, HCV viremia or the severity of HCV liver disease.