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Meta-Analysis
. 2014 Jul 17;9(7):e101493.
doi: 10.1371/journal.pone.0101493. eCollection 2014.

The effect of HIV-hepatitis C co-infection on bone mineral density and fracture: a meta-analysis

Tyler J O'Neill  1 , Laura Rivera  1 , Vladi Struchkov  2 , Ahmad Zaheen  3 , Hla-Hla Thein  4
Affiliations
Meta-Analysis

The effect of HIV-hepatitis C co-infection on bone mineral density and fracture: a meta-analysis

Tyler J O'Neill et al. PLoS One. .

Abstract

Objective: There is a variable body of evidence on adverse bone outcomes in HIV patients co-infected with hepatitis C virus (HCV). We examined the association of HIV/HCV co-infection on osteoporosis or osteopenia (reduced bone mineral density; BMD) and fracture.

Design: Systematic review and random effects meta-analyses.

Methods: A systematic literature search was conducted for articles published in English up to 1 April 2013. All studies reporting either BMD (g/cm2, or as a T-score) or incident fractures in HIV/HCV co-infected patients compared to either HIV mono-infected or HIV/HCV uninfected/seronegative controls were included. Random effects meta-analyses estimated the pooled odds ratio (OR) and the relative risk (RR) and associated 95% confidence intervals (CI).

Results: Thirteen eligible publications (BMD N = 6; Fracture = 7) of 2,064 identified were included with a total of 427,352 subjects. No publications reported data on HCV mono-infected controls. Meta-analysis of cross-sectional studies confirmed that low bone mineral density was increasingly prevalent among co-infected patients compared to HIV mono-infected controls (pooled OR 1.98, 95% CI 1.18, 3.31) but not those uninfected (pooled OR 1.47, 95% CI 0.78, 2.78). Significant association between co-infection and fracture was found compared to HIV mono-infected from cohort and case-control studies (pooled RR 1.57, 95% CI 1.33, 1.86) and compared to HIV/HCV uninfected from cohort (pooled RR 2.46, 95% CI 1.03, 3.88) and cross-sectional studies (pooled OR 2.30, 95% CI 2.09, 2.23).

Conclusions: The associations of co-infection with prevalent low BMD and risk of fracture are confirmed in this meta-analysis. Although the mechanisms of HIV/HCV co-infection's effect on BMD and fracture are not well understood, there is evidence to suggest that adverse outcomes among HIV/HCV co-infected patients are substantial.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Identification of relevant literature on HIV/HCV co-infection and outcomes of (i) low bone mineral density (BMD) and (ii) fracture.
BMD, bone mineral density; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Figure 2
Figure 2. Odds of low bone mineral density between individuals co-infected with HIV and hepatitis C virus compared to HIV mono- (A) or uninfected (B) individuals.
HIV, human immunodeficiency virus; HCV, hepatitis C virus.
Figure 3
Figure 3. Risk of fracture between individuals co-infected with HIV and hepatitis C virus compared to HIV mono- (A) or uninfected individuals (B), with odds of fracture estimated from cross-sectional studies comparing HIV/HCV co-infected patients to HIV or HCV uninfected individuals (C).
HIV, human immunodeficiency virus; HCV, hepatitis C virus.
See this image and copyright information in PMC

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