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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.

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  1. 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., InfectiousDiseases., Barcelona, Spain, 2Universitat Autònoma de Barcelona, IDIAP Jordi Gol PrimaryCareResearchInstitute, Barcelona, Spain, 3Hospital del Mar, Internal Medicine, Barcelona, Spain

  2. Author conflict of interest • Consultation fees to: • Gilead Sciences • ViiV healthcare • Abbvie • Bristol Myers Squibb • Janssen-Cilag

  3. 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.

  4. 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 

  5. 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).

  6. 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.

  7. Age-specific fracture incidence-rates (/1000 person-years) in HIV infected VS uninfected patients.

  8. HazardRatio (HR) for hip, andall clinical fractures for HIV infected VS uninfectedpatients. IR = incidencerate; py = person-years at risk; CI = confidenceinterval. aFurtheradjustedforbodymassindex, smoking, alcohol use, oral corticosteroid use, and thefollowingcomorbidconditions (as listed in theCharlsoncomorbidityindex): type 2 diabetes, chronicobstructivepulmonarydisease, heartfailure, myocardialinfarction, rheumatoidarthritis, cardiovascular disease, peripheral vascular disease, renal failure, liverdisease, malignancy, paraplegia, ulcer, and dementia.

  9. Conclusion • We found a strong association between HIV infection and hip fracture incidence , with an almost 5-fold increased risk in the HIV-infected 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.

  10. 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.

  11. Thank You Hospital del Mar. Barcelona. Spain

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