# MRI Assessment of Hip Fracture Risk and Therapy Response in HIV/HCV Coinfection

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2020 · $536,630

## Abstract

Project Summary
Within a year of hip fracture 20-30% of patients die, and 50% percent lose the ability to walk. A consensus exists
that infection with the human immunodeficiency virus (HIV) or the hepatis C virus (HCV) increases the likelihood
of fracture risk. Co-infection with HIV and HCV is prevalent - - one third of infected HIV patients are also infected
with HCV) - - thus the risk of hip fracture in this population is greatly pronounced. Evidence suggests that current
standard modalities used to measure bone strength, dual energy X-ray absorptiometry (DXA) and the Fracture
Risk Assessment Tool (FRAX), underestimate this risk in HIV+/HCV+ patients.
 To address this issue, we will apply novel magnetic resonance imaging (MRI) methods to the proximal femur
(i.e., hip) in three patient cohorts available through a recently funded NIH project in order to determine how MRI
analyzes bone deficits inaccessible by BMD/FRAX scores, how the methodology may provide clinical tools useful
for future HIV+/HCV+ trials, and how direct-acting antiviral (DAA) treatment of HCV affects bone strength in light
of possible future treatment innovations for fracture risk in HIV+/HCV+ and HCV+ patients.
 In this work, the investigators propose to test and compare bone strength, trabecular microstructure, cortical
porosity, and marrow fat using MRI of the proximal femur in HIV+/HCV+ patients, in HCV+ patients, and in
unaffected individuals. HIV+/HCV+ coinfection is predicted to decrease bone strength, present abnormal
trabecular structure, increase cortical porosity, and present abnormal marrow fat fraction, in comparison to the
HCV+ and uninfected cohorts. Group differences are predicted to be less pronounced in BMD as assessed by
DXA and FRAX scores.
 Identical parameters will be tested for each of the three cohorts 18 months after initiation of a 12-week
treatment of DAA therapy in HIV+/HCV+ and HCV+ individuals. Treating HIV with antiretroviral therapy (ART) is
known to have immediate negative effects on overall bone strength, but less information exists about bone deficit
changes following HCV cure with DAA treatment. Cure of HCV is predicted to result in increased bone strength,
improved trabecular microstructure, decreased cortical porosity, and improved marrow fat fraction in the HCV+
and HIV+/HCV+ cohorts, but again predicted to be less pronounced as assessed by DXA and FRAX scores.
The HCV+ cohort is predicted to have larger positive changes concerning these parameters in comparison to
the HIV+/HCV+ group.
 The proposed project has the potential to change and improve how bone disease is clinically managed and
to reduce the burdens of hip fractures in patients infected with HIV and HCV.

## Key facts

- **NIH application ID:** 10017007
- **Project number:** 5R01AR076392-02
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Chamith Sudesh Rajapakse
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $536,630
- **Award type:** 5
- **Project period:** 2019-09-11 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10017007

## Citation

> US National Institutes of Health, RePORTER application 10017007, MRI Assessment of Hip Fracture Risk and Therapy Response in HIV/HCV Coinfection (5R01AR076392-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10017007. Licensed CC0.

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