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Objective: \udWe  assessed  the  prevalence  and  risk  factors  of  decreased  bone  mineral  density  (BMD)  in  patients  mono-infected  with  human immunodeficiency virus (HIV) or co-infected with hepatitis  C  virus (HIV/HCV).  We  also  evaluated whether bone loss was linked to lipid asset in both groups and to severity of liver fibrosis in the co-infected group.\udMethods: \udWe consecutively enrolled 194 HIV-patients (129 mono-infected\ud and 65 co-infected). All HIV-patients underwent dual-energy  X-ray  absorptiometry  (DXA),  while  co-infected patients  underwent transient  elastography.  Advanced liver fibrosis was defined as a median liver stiffness ≥ 9.5 kPa. Fibrosis was also assessed in all the HIV-patients using FIB-4.\udResults: \udThe  overall  prevalence  of  low  BMD  and  osteoporosis  was  26.8%  and  26.0%,  respectively.  It  was significantly higher among HIV/HCV co-infected than mono-infected patients in lumbar/femoral sites (P<0.04 and P<0.05, respectively). HDL-cholesterol levels correlated independently with lumbar DXA Z-score (P<0.03) in HIV mono-infected subjects. Liver stiffness correlated negatively and independently with femoral Z- and T-scores among co-infected patients (P<0.003; P<0.01, respectively). Stratifying co-infected subjects by sex, liver stiffness and lumbar/femoral Z-scores (P<0.04) or T-scores (P<0.05; P<0.04, respectively) correlated negatively only in the females. Longer PI exposure was negatively and independently correlated with BMD.\udConclusion: \udOur  HIV-infected  patients  appeared  at  high  risk  for  low  BMD  and  osteoporosis. Severity  of  liver fibrosis was an independent predictor of bone loss in co-infection, although other factors could affect the skeletal \udsystem in HIV/HCV co-infection. Further research into the impact of liver fibrosis and lipid asset on bone disease in HIV-infection is necessary

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients