# Rates and determinants of decreased bone health among HIV-infected patients

> **NIH VA I01** · VA NORTH TEXAS HEALTH CARE SYSTEM · 2020 · —

## Abstract

HIV and HCV infections are associated with an increased risk of osteoporotic fractures (OF). HIV/HCV co-
infected subjects have a 3-fold increased fracture incidence compared to uninfected individuals, and 50%
greater risk than HIV mono-infected. Despite being associated with this much higher fracture risk, HIV/HCV co-
infection is not associated with lower bone mineral density (BMD) than HIV alone. The increased OF risk
associated with HCV is likely mediated by micro-architectural changes that can be assessed using a novel
technology called trabecular bone score (TBS) and possibly faster BMD decline. We have confirmed the
existence of these HCV-associated micro-architectural changes in our preliminary studies and would now like
to explore whether they underlie the increased fracture risk. Utilizing our ongoing cohort of 540 participants (57
HIV/HCV, 174 HIV, 131 HCV and 178 uninfected) we will evaluate longitudinal changes of BMD and TBS HIV
and HCV patients.
Validation of BMD and BMD changes on fracture risk in HIV and HCV populations has not been carried. Due
to its deleterious effects on BMD, tenofovir disoproxil fumarate (TDF) is now largely being replaced in HIV
therapy by the analog tenofovir alafenamide (TAF). The beneficial effects of this switch have also not been
evaluated in a large cohort. Neither have the adherence and effectiveness of fracture preventive measures in
HIV and HCV. Analyzing the use and effectiveness of these preventive measures and antiretroviral therapy
changes will be the second aim of our study. To achieve this aim, we will utilize our prospective cohort and the
much larger retrospective cohort of patients receiving care across the VA network, using a novel Natural
Language Processing tool to extract anti-osteoporosis medication prescriptions, BMD and fracture data from
the records.
Finally, whether HCV-associated fracture risk is improved with HCV cure with interferon is doubtful based on
recent evidence. The effects of current HCV therapy with Direct-Acting Antivirals (DAA) on OF risk has not
been evaluated, and will constitute the third aim of our work. Our findings will have immediate therapeutic
implications for Veterans: 1) understanding the mechanism(s) of increased fracture risk associated with HCV
will allow targeted preventive and therapeutic interventions; 2) analyzing longitudinal changes in BMD and TBS
in HIV and HCV will further elucidate mechanisms of increased fracture risk, and inform whether current
monitoring guidelines are adequate; 3) determining whether HCV therapy with DAAs improves HCV-related
increased fracture risk will inform whether additional measures should be taken to mitigate it; 4) determining
whether the beneficial effect of antiretroviral switches on BMD seen in trials will be confirmed in improved
fracture risk in a large clinical cohort will validate current trends in antiretroviral therapy; 5) evaluating the
association of BMD and fracture risk in a large cohort of HIV and non...

## Key facts

- **NIH application ID:** 9813946
- **Project number:** 5I01CX000418-06
- **Recipient organization:** VA NORTH TEXAS HEALTH CARE SYSTEM
- **Principal Investigator:** Roger Bedimo
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2011-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9813946

## Citation

> US National Institutes of Health, RePORTER application 9813946, Rates and determinants of decreased bone health among HIV-infected patients (5I01CX000418-06). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9813946. Licensed CC0.

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