Genotype 3 HCV infection, lower CD4 cell count and higher liver stiffness are related with bone mineral reduction in HIV/HCV co-infected patients (MASTER cohort)

Background : In HIV/HCV co-infected patients (pts),the bone mineral density (BMD) abnormality and risk of fracture are higher than in HIV or HCV mono-infected subjects (O’Neill JDet al.PlosONe,2104). To study the variables related with low BMD in HIV/HCV co-infected pts, a retrospective analysis of MASTER cohort was implemented Materials & Methods : All sequential HIV and HCV Ab+ patients, enrolled in the observational Italian MASTER database, who performed at least one DEXA scan between 2010 and 2013, based on national and international recommendation, were enrolled.Baseline was defined when DEXA scan was performed. Socio-demographics variables, clinic and laboratory data in pts. with abnormal DEXA scan (T score < -1) or with normal DEXA scan are compared and analyzed. Osteopenia and osteoporosis were defined following the WHO classification (http://www.whqlibdoc.who.int/trs/WHO_TRS_ 921.pdf). Abstract 51 Reviews in Antiviral Therapy & Infectious Diseases 2015_5 Elastometry was used to define liver fibrosis. Multivariate statistic analysis was performed to detect variables related with abnormal DEXA scan. Analysis was adjusted for the following covariates: age, sex, HCV genotype, presence of SVR after peg-IFN plus ribavirin, liver fibrosis stage, CD4 cell count, HIV viral load, time to HCV exposure, tenofovir use, use of boosted protease inhibitor (PI), calcium, phosphate and 25OH vitamin D plasma level, presence of proteinuria, menopause in women. Results : The number of HIV/HCV co-infected pts enrolled was 86. In 34/86 (39,5%) the DEXA scan was abnormal: in 27/34 (79,4%) osteopenia was detected and in 7/34 (20,6%) osteoporosis was diagnosed. The median age was 53 and 54 years (IQR 51-54 in booth groups) in pts with abnormal or normal examination respectively; 82 pts. were on cART. All subjects assumed tenofovir and 68% a boosted protease inhibithor. HIV-RNA was undetectable in 93%. CD4+ cell count tended to be lower when DEXA was abnormal (433 cell/mm 3 vs 514 cell/mm 3 p0.07). The exposure to HCV infection was 9.5 years (IQR 7-23) in pts with abnormal and 13 years (10-14) in pts with normal DEXA (p 0.02). Presence of SVR and menopause, among women, were not related with abnormal or normal DEXA. At multivariate analysis, variables related with abnormal DEXA were HCV genotype 3 infection [AOR3,3(1,0- 10,9)0,04];T CD4+ cell count < 500 cell/mm3 [AOR 3,6 (95%IC1 ,1-11,7)0,03] and a liver stiffness > 7,5Kpa[AOR 3,5(1,0-11,6)0,03] Conclusion: In HIV/HCV co-infected pts, included in the MASTER cohort, who performed a DEXA scan, following the international and national guidelines, 40% had an abnormal examination. Genotype 3, lower CD4+ cell count and higher liver stiffness were related with abnormal DEXA despite having achieved SVR