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SHBG, bone mineral density and physical function among injection drug users with and without HIV and HCV.

BACKGROUND
Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates the bioavailability of sex hormones and is higher in people with HIV (PWH) and hepatitis C (HCV). SHBG is associated with aging-related diseases, including osteoporosis and frailty in the general population. However, the relationship between SHBG concentration and bone mineral density (BMD) and physical function among PWH and HCV is unclear.


METHODS
A cross-sectional study of 278 HCV-exposed (HCV antibody positive) adults enrolled with and without HIV and HCV from the AIDS Linked to the IntraVenous Experience cohort study into four groups: HCV-/HIV-, HCV-/HIV+, HCV+/HIV-, HCV+/HIV+. We evaluated the association between SHBG concentrations and grip strength, gait speed, short physical performance battery score, frailty (Fried Frailty Phenotype) and BMD (lumbar spine, total hip and femoral neck T-score) by using adjusted multivariable regression stratified by sex.


RESULTS
SHBG concentrations were higher in women, in those with HIV RNA>400 copies/ml (p=0.02) and HCV RNA >15 IU/ml (p<0.001). In adjusted models, higher SHBG concentrations among women were significantly associated with lower grip strength (-0.43[95%CI:-0.77, -0.081] kg/10 nmol/L, p<0.05), higher odds of frailty (OR, 1.49[95%CI:1.07,2.08], p<0.05) and lower T-scores at the lumbar spine (-0.070[95%CI:-0.15,-0.001] SD/10 nmol/L T-score BMD, p<0.05). Similar associations were not observed among men.


CONCLUSION
Higher SHBG concentrations are associated with the presence of HIV and HCV viremia. Among women, but not men, higher SHBG concentrations were associated with lower grip strength, higher odds of frailty, and lower lumbar spine BMD. The underlying mechanisms of these associations require further investigation.