Incidence of low- and high-energy fractures in persons with and without HIV-infection: a Danish population-based cohort study

TY - JOUR

T1 - Incidence of low- and high-energy fractures in persons with and without HIV-infection: a Danish population-based cohort study

AU - Hansen, Ann-Brit E

AU - Gerstoft, Jan

AU - Kronborg, Gitte

AU - Larsen, Carsten Schade

AU - Pedersen, Court

AU - Pedersen, Gitte

AU - Obel, Niels

PY - 2012/1/28

Y1 - 2012/1/28

N2 - Objective: To compare fracture risk in persons with and without HIV infection and to examine the influence of highly active antiretroviral therapy (HAART) initiation on risk of fracture. Design: Population-based nationwide cohort study using Danish registries. Methods: Outcome measures were time to first fracture at any site, time to first low-energy and high-energy fracture in HIV-infected patients (n=5306) compared with a general population control cohort (n=26530) matched by sex and age during the study period 1995-2009. Cox regression analyses were used to estimate incidence rate ratios (IRRs). Results: HIV-infected patients had increased risk of fracture [IRR 1.5, 95% confidence interval (CI) 1.4-1.7] compared with population controls. The relative risk was lower in HIV-monoinfected patients (IRR 1.3, 95% CI 1.2-1.4) than in HIV/hepatitis C virus (HCV)-coinfected patients (IRR 2.9, 95% CI 2.5-3.4).Both HIV-monoinfected and HIV/HCV-coinfected patients had increased risk of low-energy fracture, IRR of 1.6 (95% CI 1.4-1.8) and 3.8 (95% CI 3.0-4.9). However, only HIV/HCV-coinfected patients had increased risk of high-energy fracture, IRR of 2.4 (95% CI 2.0-2.9). Among HIV-monoinfected patients the risk of low-energy fracture was only significantly increased after HAART exposure, IRR of 1.8 (95% CI 1.5-2.1). The increased risk in HAART-exposed patients was not associated with CD4 cell count, prior AIDS, tenofovir or efavirenz exposure, but with comorbidity and smoking. Conclusion: HIV-infected patients had increased risk of fracture compared with population controls. Among HIV-monoinfected patients the increased risk was observed for low-energy but not for high-energy fractures, and the increased risk of low-energy fracture was only observed in HAART-exposed patients.

AB - Objective: To compare fracture risk in persons with and without HIV infection and to examine the influence of highly active antiretroviral therapy (HAART) initiation on risk of fracture. Design: Population-based nationwide cohort study using Danish registries. Methods: Outcome measures were time to first fracture at any site, time to first low-energy and high-energy fracture in HIV-infected patients (n=5306) compared with a general population control cohort (n=26530) matched by sex and age during the study period 1995-2009. Cox regression analyses were used to estimate incidence rate ratios (IRRs). Results: HIV-infected patients had increased risk of fracture [IRR 1.5, 95% confidence interval (CI) 1.4-1.7] compared with population controls. The relative risk was lower in HIV-monoinfected patients (IRR 1.3, 95% CI 1.2-1.4) than in HIV/hepatitis C virus (HCV)-coinfected patients (IRR 2.9, 95% CI 2.5-3.4).Both HIV-monoinfected and HIV/HCV-coinfected patients had increased risk of low-energy fracture, IRR of 1.6 (95% CI 1.4-1.8) and 3.8 (95% CI 3.0-4.9). However, only HIV/HCV-coinfected patients had increased risk of high-energy fracture, IRR of 2.4 (95% CI 2.0-2.9). Among HIV-monoinfected patients the risk of low-energy fracture was only significantly increased after HAART exposure, IRR of 1.8 (95% CI 1.5-2.1). The increased risk in HAART-exposed patients was not associated with CD4 cell count, prior AIDS, tenofovir or efavirenz exposure, but with comorbidity and smoking. Conclusion: HIV-infected patients had increased risk of fracture compared with population controls. Among HIV-monoinfected patients the increased risk was observed for low-energy but not for high-energy fractures, and the increased risk of low-energy fracture was only observed in HAART-exposed patients.

U2 - 10.1097/QAD.0b013e32834ed8a7

DO - 10.1097/QAD.0b013e32834ed8a7

M3 - Journal article

C2 - 22095195

SN - 1350-2840

VL - 26

SP - 285

EP - 293

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 3

ER -