Transcript Abstract: WEABO205. HIV infection was associated with an increased risk of hip fracture, independently of age, gender and co-morbidities: a population-based cohort study. Authors : H.

Abstract: WEABO205.
HIV infection was associated with
an increased risk of hip fracture,
independently of age, gender and
co-morbidities: a population-based
cohort study.
Authors : H. Knobel1, R. Güerri1, D. Prieto2, J. Villar1, A. Díez3, E.
Lerma1, M. Montero1, A. González1, A. Guelar1
Institutions: 1Hospital del Mar., Infectious Diseases., Barcelona,
Spain, 2Universitat Autònoma de Barcelona, IDIAP Jordi Gol
Primary Care Research Institute, Barcelona, Spain, 3Hospital del
Mar, Internal Medicine, Barcelona, Spain
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Author conflict of interest
•
-
Consultation fees to:
Gilead Sciences
ViiV healthcare
Abbvie
Bristol Myers Squibb
Janssen-Cilag
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Background
• HIV – infected patient live longer, and being confronted
with health challenges related to aging. Morbidities that
were not classically considered to be HIV related are now
found associated with ongoing HIV replication, chronic
immune activation, and with long-term HAART.
• Numerous studies have found that HIV-infected patients
have lower bone mineral density (BMD) compared with
the general population, but studies analyzing whether
low bone density actually leads to greater incidence of
fractures in HIV-infected patients have been inconclusive.
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Methods I
Study design.
• A population-based cohort study was conducted to explore
the association between HIV infection and hip and other
major osteoporotic fracture risk.
Participants.
• The Spanish public health-care system covers the practical
totality of the population. General practitioners (GPs) play
an essential role. Data was obtained from the SIDIAPQ
Database, which contains clinical information for >2 million
patients in Catalonia, Spain (30% of the total population).
• All patients aged ≥40 years in the database in the period
2007 to 2009 were eligible for this study (N = 1,118,587).
Participants with a clinical diagnosis of HIV infection were
identified
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Methods II
 Ascertainment of fractures
• We screened the database to ascertained incident hip and
osteoporotic major fractures (clinical spine, wrist/forearm,
pelvis and proximal humerus) in the population aged 40 years
or older.
• We obtained data on incident fractures involving hospital
admission from the Hospital Discharge Episodes database.
 Statistical analyses
• Cox regression models were used to estimate Hazard Ratios
(HRs) and 95% CI for the HIV-infected VS uninfected
participants. Models were adjusted for age, gender, body mass
index (BMI), smoking status, alcohol consumption, oral
glucocorticoid use, and co-morbid conditions (as the Charlson
Index).
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Results
• Among 1,118,156 eligible participants, we identified 2,489
(0.22%) HIV-infected, with a median follow-up of 3 years.
• During the study 41,907 (3.75%) patients died, 178 (7.2%) of
HIV-infected and 41,729 (3.7%) of the uninfected patients.
• During the study 49 and 24,408 of clinical fractures (12 and
7,299 hip fractures) were observed in the HIV-infected and in
the uninfected patients respectively.
• The unadjusted fracture incidence rates were 8.03/1,000
patient-years (95%CI 6.07-10.62) in the HIV-infected and
7.93/1,000 (7.83-8.03) in the non-infected patients.
• The HR for hip fracture in HIV/AIDS was 4.7 (2.4-9.5; p< 0.001)
and for all clinical fractures was1.8 (1.2-2.5; p=0.002) in the
adjusted model including all potential confounders.
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Age-specific fracture incidence-rates (/1000 person-years) in HIV
infected VS uninfected patients.
5
4.5
HIV infected
4
HIV uninfected
3.5
3
2.5
2
1.5
1
0.5
0
40-45
45-50
50-55
55-60
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60-65
65-70
70-75
75-80
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Hazard Ratio (HR) for hip, and all clinical fractures for
HIV infected VS uninfected patients.
Number of
fractures
Fracture IR/1,000
py [95%CI]
Age & Genderadjusted HR [95%CI];
p-val
Multivariate
adjusted HR*
[95%CI]; p-val
HIP FRACTURES
HIV
Uninfected
HIV
Infected
7,299
2.37 [2.31-2.42]
12
2.03 [1.15-3.57]
REF
6.16 [3.49-10.86];
p<0.001
REF
4.72 [2.35-9.47];
p<0.001
ALL CLINICAL FRACTURES
HIV
Uninfected
HIV
Infected
24,408
7.93 [7.83-8.03]
49
8.03 [6.07-10.62]
REF
2.67 [2.01-3.53];
p<0.001
REF
1.75 [1.24-2.48];
p=0.002
IR = incidence rate; py = person-years at risk; CI = confidence interval.
aFurther adjusted for body mass index, smoking, alcohol use, oral corticosteroid use, and the following comorbid conditions (as
listed in the Charlson comorbidity index): type 2 diabetes, chronic obstructive pulmonary disease, heart failure, myocardial
infarction, rheumatoid arthritis, cardiovascular disease, peripheral vascular disease, renal failure, liver disease, malignancy,
paraplegia, ulcer, and dementia.
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Conclusion
• We found a strong association between HIV
infection and hip fracture incidence , with an
almost 5-fold increased risk in the HIVinfected patients, independently of gender,
age, body mass index, smoking, alcohol
consumption and other co-morbidities.
• We report a 75% higher risk of all clinical
fractures among HIV-infected patients.
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Discussion
• Limitations.
- The lack of individual validation of each one of the fractures
observed.
- The lack of detailed information on HIV infection as well as on
antiretroviral therapies used.
- The low number of HIV-infected patients included among the
elderly suggests that the age-stratified results should be
interpreted with caution.
• Strengths
- The high representativeness of the data used (covers 30% of the
total population)
- Loss to follow-up is low (<2.5%) when compared with other
cohort studies, which limits the possibility of loss to follow-up
bias.
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Thank You
Hospital del Mar. Barcelona. Spain
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