Co-infection with hepatitis B or C is
associated with reduced bone mineral density (BMD) in women living with HIV,
French investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators
compared bone mineral density between people with HIV infection alone and people with chronic viral hepatitis co-infection.
“The hypothesis of an epidemiological
association between viral hepatitis and osteoporosis was the central aim of our
study and was only confirmed in our HIV-infected female patients,” write the
authors. “Further longitudinal studies are needed to elucidate the relationship
between osteoporosis and chronic viral hepatitis, including inflammatory processes
accelerating bone mass loss.”
A substantial body of research has shown a
high prevalence of reduced bone mineral density in people living with HIV. The exact
causes are uncertain but may include traditional reasons such as ageing and
smoking, the damage caused by untreated HIV infection and the side-effects of
some antiretroviral drugs.
A large number of people living with HIV are
co-infected with hepatitis B or hepatitis C. The prevalence of osteoporosis in
people with chronic liver disease has been shown to be as high as 56% in some
studies. This prompted investigators in southern France to hypothesise that people with both HIV and chronic viral hepatitis would have an
especially high risk of osteoporosis. They therefore designed a study comparing
the bone mineral density of people with these co-infections and people with HIV
Participants were recruited between 2004-05 and
2008-09. Scans were used to measure bone mineral density in the lumbar spine,
femoral neck (hip) and total body.
The study population consisted of 626 people, 269 of whom had chronic viral hepatitis co-infection (208 with
hepatitis C, 45 with hepatitis B and 16 with both).
Overall, the study participants had a median age of
44 years and 27% were female (31% postmenopausal). The majority of participants
(71%) had an undetectable viral load and the median CD4 cell count was 506
Rates of osteopenia (mild reduction in bone
mineral density) were similar between people who had co-infection and HIV-monoinfection
(49 vs 53%).
However, prevalence of osteoporosis was
significantly higher among those with viral hepatitis co-infection (35 vs 26%, p =
Factors associated with low bone mineral
density among male participants were increasing age (each additional ten years, OR =
2.0; 95% CI, 1.3-3.0; p < 0.001); being in the MSM (men who have sex with men) risk group (OR = 3.6; 95%
CI, 1.6-8.2; p = 0.0021); and a body mass index (BMI) below 20 kg/m2
(OR = 12.1; 95% CI, 2.6-56.2; p = 0.0015). Viral hepatitis co-infection was not
a risk factor.
Among women, the risk factors were older
age (each additional ten years, OR =15.2; 95% CI, 3.6-65.5); BMI below 20 kg/m2
(OR = 18.4; 95% CI, 1.6-217.9; p = 0.0208) and viral hepatitis co-infection (OR
= 19; 95% CI, 1.0=349.8; p = 0.0474).
“Our study strongly suggests that chronic
viral hepatitis is associated with osteoporosis in HIV-infected women,” comment
They believe their findings have
implications for patient care. “For osteopenic and osteoporotic co-infected
patients, preventive programs to reduce the BMD decline and the risk of
fracture may be considered, while considering the specific needs of women, and
should take into account well-known risk-factors (low BMI and older age).”