Article first published online: 14 OCT 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 56, Issue 5, pages 1688–1698, November 2012
How to Cite
Lo Re, V., Volk, J., Newcomb, C. W., Yang, Y.-X., Freeman, C. P., Hennessy, S., Kostman, J. R., Tebas, P., Leonard, M. B. and Localio, A. R. (2012), Risk of hip fracture associated with hepatitis c virus infection and hepatitis C/human immunodeficiency virus coinfection. Hepatology, 56: 1688–1698. doi: 10.1002/hep.25866
Potential conflicts of interest: Dr. Lo Re received grants from Astra Zeneca and Gilead. Dr. Kostman is a consultant for, advises, and is on the speakers' bureau of Merck and Vertex.
This study was supported by the National Institute of Allergy and Infectious Diseases (research grants K01-AI070001 and U01-AI069467), the National Institute of Diabetes and Digestive and Kidney Diseases (research grant K24-DK076808), the Clinical and Translational Science Award from the National Institutes of Health (grant no.: UL1-RR024134), and a Penn FOCUS Medical Student Fellowship in Women's Health (Bertha Dagan Berman Award).
- Issue published online: 31 OCT 2012
- Article first published online: 14 OCT 2012
- Accepted manuscript online: 22 MAY 2012 11:26AM EST
- Manuscript Accepted: 15 MAY 2012
- Manuscript Received: 11 FEB 2012
Hepatitis C virus (HCV) infection has been associated with reduced bone mineral density, but its association with fracture rates is unknown, particularly in the setting of human immunodeficiency virus (HIV) coinfection. Our aims were to determine whether persons with HCV infection alone are at increased risk for hip fracture, compared to uninfected individuals, and to examine whether the risk of hip fracture is higher among HCV/HIV-coinfected persons, compared to those with HCV alone, those with HIV alone, and those uninfected with either virus. We conducted a cohort study in 36,950 HCV/HIV-coinfected, 276,901 HCV-monoinfected, 95,827 HIV-monoinfected, and 3,110,904 HCV/HIV-uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999-2005). Incidence rates of hip fracture were lowest among uninfected persons (1.29 events/1,000 person-years), increased with the presence of either HIV infection (1.95 events/1,000 person-years) or HCV infection (2.69 events/1,000 person-years), and were highest among HCV/HIV-coinfected individuals (3.06 events/1,000 person-years). HCV/HIV coinfection was associated with an increased relative hazard (adjusted hazard ratio [HR] [95% confidence interval; CI]) of hip fracture, compared to HCV-monoinfected (HR, 1.38; 95% CI: 1.25-1.53), HIV-monoinfected (females: HR, 1.76; 95% CI: 1.44-2.16; males: HR, 1.36; 95% CI: 1.20-1.55), and HCV/HIV-uninfected persons (females: HR, 2.65; 95% CI: 2.21-3.17; males: HR, 2.20; 95% CI: 1.97-2.47). HCV monoinfection was associated with an increased risk of hip fracture, compared to uninfected individuals, and the relative increase was highest in the youngest age groups (females, 18-39 years: HR, 3.56; 95% CI: 2.93-4.32; males, 18-39 years: HR, 2.40; 95% CI: 2.02-2.84). Conclusion: Among Medicaid enrollees, HCV/HIV coinfection was associated with increased rates of hip fracture, compared to HCV-monoinfected, HIV-monoinfected, and HCV/HIV-uninfected persons. HCV-monoinfected patients had an increased risk of hip fracture, compared to uninfected individuals. (HEPATOLOGY 2012;56:1688–1698)