Journal of Isfahan Medical School

Journal of Isfahan Medical School

Frequency Distribution of Fractures among Hepatitis C Virus (HCV)- or Human Immunodeficiency Virus (HIV)-Positive Patients Referred to Hospital Orthopedic Surgery Wards

Document Type : Original Article (s)

Authors
Mohammad Dehghani 1
Mohammadhadi Nouraei 1
Golnaz Alinia 2
Shaghayegh Dehghani 2
1 Associate Professor, Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Some of studies showed that Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and related drugs not only have effect on liver and immunity systems but also have effect on musculoskeletal and bone mass density and led to increase of fractures risk; investigations about these effects are limited. The aim of this study was   determining the frequency distribution of fractures among HCV- or HIV-positive patients referred to hospital orthopedic surgery wards.Methods: In a cross-sectional study during 2012-2014, 132 HCV- or HIV-positive patients hospitalized to Kashani and Alzahra hospitals (Isfahan, Iran) due to fractures were studied. Fracture status, improvement time and complications due to fracture were investigated. Findings: Of 132 studied patients, 87 (65.9%) were HCV-positive, 21 (15.9%) HIV-positive, 17 (12.9%) HCV- and HIV-positive and 7 (5.3%) were HCV-positive with cancer. The most prevalent of damage was femur fracture that happened in 69 (52.3%) patients. Kind of damage was related to background diseases and frequency distribution of femur fracture (as the most frequent fracture) in HCV-, HIV-, HCV- and HIV- and HCV-positive with cancer patients was 48.3, 28.6, 88.2 and 85.7 percent, respectively. In addition, the frequency distribution of complications was different based on the kind of background diseases (P = 0.001).    Conclusion: According to the results of this study, prevalence of bone fracture in HCV- or HIV-positive patients was high and probably, was related to lock of bone mass density and increase of bone fracture risk. In addition, post-treatment complications such as infection and un-union were prevalent in these patients. Hence, prevention activities and routine surveillances such as bone densitometry and musculoskeletal surveillance mast be done in these patients.
Keywords
Hepatitis C virus (HCV)
Human Immunodeficiency virus (HIV)
Fracture
  1. Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002; 36(5 Suppl 1): S35-S46.
  2. Gallego-Rojo FJ, Gonzalez-Calvin JL, Munoz-Torres M, Mundi JL, Fernandez-Perez R, Rodrigo-Moreno D. Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis. Hepatology 1998; 28(3): 695-9.
  3. Rouillard S, Lane NE. Hepatic osteodystrophy. Hepatology 2001; 33(1): 301-7.
  4. Gonzalez-Calvin JL, Gallego-Rojo F, Fernandez-Perez R, Casado-Caballero F, Ruiz-Escolano E, Olivares EG. Osteoporosis, mineral metabolism, and serum soluble tumor necrosis factor receptor p55 in viral cirrhosis. J Clin Endocrinol Metab 2004; 89(9): 4325-30.
  5. Gilbert L, He X, Farmer P, Rubin J, Drissi H, van Wijnen AJ, et al. Expression of the osteoblast differentiation factor RUNX2 (Cbfa1/AML3/Pebp2alpha A) is inhibited by tumor necrosis factor-alpha. J Biol Chem 2002; 277(4): 2695-701.
  6. Pignata S, Daniele B, Galati MG, Esposito G, Vallone P, Fiore F, et al. Oestradiol and testosterone blood levels in patients with viral cirrhosis and hepatocellular carcinoma. Eur J Gastroenterol Hepatol 1997; 9(3): 283-6.
  7. Lo RV, III, Volk J, Newcomb CW, Yang YX, Freeman CP, Hennessy S, et al. Risk of hip fracture associated with hepatitis C virus infection and hepatitis C/human immunodeficiency virus coinfection. Hepatology 2012; 56(5): 1688-98.
  8. McComsey GA, Tebas P, Shane E, Yin MT, Overton ET, Huang JS, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis 2010; 51(8): 937-46.
  9. Richardson J, Hill AM, Johnston CJ, McGregor A, Norrish AR, Eastwood D, et al. Fracture healing in HIV-positive populations. J Bone Joint Surg Br 2008; 90(8): 988-94.
  10. Carter M. HIV/hepatitis C co-infection increases risk of hip fracture [Online]. [cited]; 2012 Jun 19; Available from: URL: http://www.aidsmap.com/HIVhepatitis-C-co-infection-increases-risk-of-hip-fracture/page/2391380/
  11. Gallant JE, Staszewski S, Pozniak AL, DeJesus E, Suleiman JM, Miller MD, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 2004; 292(2): 191-201.
  12. Mondy K, Yarasheski K, Powderly WG, Whyte M, Claxton S, DeMarco D, et al. Longitudinal evolution of bone mineral density and bone markers in human immunodeficiency virus-infected individuals. Clin Infect Dis 2003; 36(4): 482-90.
  13. Tebas P, Powderly WG, Claxton S, Marin D, Tantisiriwat W, Teitelbaum SL, et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000; 14(4): F63-F67.
  14. Fakruddin JM, Laurence J. HIV envelope gp120-mediated regulation of osteoclastogenesis via receptor activator of nuclear factor kappa B ligand (RANKL) secretion and its modulation by certain HIV protease inhibitors through interferon-gamma/RANKL cross-talk. J Biol Chem 2003; 278(48): 48251-8.
  15. Gibellini D, De Crignis E, Ponti C, Cimatti L, Borderi M, Tschon M, et al. HIV-1 triggers apoptosis in primary osteoblasts and HOBIT cells through TNFalpha activation. J Med Virol 2008; 80(9): 1507-14.
  16. Szczesny G, Olszewski WL, Zagozda M, Rutkowska J, Czapnik Z, Swoboda-Kopec E, et al. Genetic factors responsible for long bone fractures non-union. Arch Orthop Trauma Surg 2011; 131(2): 275-81.
  17. Dong HV, Cortes YI, Shiau S, Yin MT. Osteoporosis and fractures in HIV/hepatitis C virus coinfection: a systematic review and meta-analysis. AIDS 2014; 28(14): 2119-31.
  18. Li Vecchi V, Soresi M, Giannitrapani L, Mazzola G, Colletti P, et al. Associated factors and liver disease severity for decreased bone mineral density in HIV mono- and HIV/HCV co-infected patients. J AIDS Clin Res 2015; 6(3):438.
  19. O'Neill TJ, Rivera L, Struchkov V, Zaheen A, Thein HH. The effect of HIV-hepatitis C co-infection on bone mineral density and fracture: a meta-analysis. PLoS One 2014; 9(7): e101493.
Journal of Isfahan Medical School
Volume 33, Issue 341 - Serial Number 341
May and June 2015
Pages 1057-1065

  • Receive Date 11 July 2015
  • Accept Date 06 April 2022