Coinfection With Hepatitis B or C Is a Risk Factor for Reduced Bone Mineral Density Among Women With HIV

French researchers report that HIV-infected women are more likely to develop osteoporosis -- reduced bone mineral density -- if they also have hepatitis B or C. Previous studies have documented high prevalence of osteoporosis among HIV-infected people, perhaps due to smoking, aging, HIV infection, or antiretroviral drug use. Research has also confirmed a high rate of osteoporosis -- up to 56 percent -- among people with chronic liver disease. Since many HIV-infected people also have hepatitis B or C, the French study examined whether co-infection increased the prevalence of osteopenia (mild reduction in bone mineral density) or osteoporosis in men and women.

The study recruited 626 HIV-infected people, from 2004 to 2005 and from 2008 to 2009, for bone density scans of the lumbar spine, hip, and total body. Most participants had an undetectable viral load. Of the 269 group participants who were co-infected with hepatitis, 208 had hepatitis C, 45 had hepatitis B, and 16 had both B and C. The median age of study participants was 44, and females comprised more than a quarter of participants (27 percent).

There was little difference in the rates of osteopenia among HIV-infected people and people who had both HIV and hepatitis, but the prevalence of osteoporosis was higher for co-infected people. Osteoporosis risk factors for men included age, sexual activity with other men, and lower body mass index (BMI). Co-infection with hepatitis was not associated with increased risk. In contrast, age, lower BMI, and co-infection with hepatitis increased the risk of osteoporosis for co-infected women. Researchers advised healthcare providers to include preventive measures to reduce "BMI decline" and risk of fracture for co-infected women.

The full report, "Chronic Viral Hepatitis Is Associated With Low Bone Mineral Density in HIV-Infected Patients, ANRS CO 3 Aquitaine Cohort," was published online in the Journal of Acquired Immune Deficiency Syndromes (2013; doi: 10.1097/QAI.0b013e3182845d88).

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