CD4 count <200 independently associated with 5-fold increased risk of fracture
Simon Collins, HIV i-Base
A study published in the July 1st edition of JAIDS by Michelle Yong from The Alfred Hospital, Melbourne, reported a significant association between CD4 count and risk of fractures that was independent of traditional risk factors including corticosteroid use.
The group performed a 1:2 matched case-control study in HIV positive patients attending a single hospital site between 1998 and 2009. Controls were matched on gender, age, and duration of HIV infection.
The overall fracture incidence rate was 0.53 per 100 person-years (95%CI: 0.43 to 0.65) and period prevalence of 3.34 per 100 patients (95% CI: 2.66 to 4.13). There were 73 low trauma fractures in 61 patients. Patients were predominantly male (89%) with a mean age of 49.8 years. Independent risk factors for fragility fracture were a CD4 cell count <200 cells/mm3 (OR 4.91: 95% CI 1.78 to 13.57, p = 0.002), corticosteroids (OR 8.96: 95% CI 1.55 to 51.88, p = 0.014) and anti-epileptic medications (OR: 8.88: 95% CI 1.75 to 44.97, p = 0.008).
No association was found between risk of fracture and HIV viral load (p = 0.18), use of antiretrovirals or class of antiretroviral medication. The majority patients with fracture (88%) had osteopenia or osteoporosis.
Yong MK et al. Low CD4 count is associated with an increased risk of fragility fracture in HIV-infected patients. JAIDS, 1 July 2011 – Volume 57 – Issue 3 – pp 205-210