Objectives The standard treatment for giant cell arteritis (GCA) are high dose glucocorticoids (GC). It is unknown whether GC are more detrimental to bone mineral density (BMD) at the spine or the hip. The aim of this study was to investigate the effect of GC on BMD at the lumbar spine and hip in patients with GCA being treated with GC. Methods Patients who were referred for a dual-energy X-ray absorptiometry (DXA) at a hospital in the North-West of England between 2010 and 2019 were included. Two patient groups were identified, patients with GCA on current GC (cases) matched 1:4 based on age and gender to those referred to the scanner with no indication for scanning (controls). Logistic models were fitted looking at the spine and hip BMD unadjusted and adjusted for height and weight. Results As would be expected, this gave an adjusted odds ratio (OR) of 0.280 (95%CI 0.071; 1.110) at lumbar spine, OR of 0.238 (95%CI 0.033; 1.719) at left femoral neck, OR of 0.187 (95%CI 0.037; 0.948) at right femoral neck, OR of 0.005 (95%CI 0.001; 0.021) of left total hip and OR of 0.003 (95%CI 0.001; 0.015) at right total hip. Conclusion The study has shown patients diagnosed with GCA receiving GC treatment have a lower BMD at the right femoral neck, left total hip and right total hip compared with the controls in patients of the same age and gender after adjusting for height and weight. Lay summary What does this mean for patients ? Giant cell arteritis (GCA) is the most common type of inflammation affecting medium and large vessels. Glucocorticoids (GC) are the main treatment for GCA and are helpful in preventing serious eye complications including blindness. Studies have shown various results of GC treatment in patients diagnosed with GCA causing a decrease in bone mineral density (BMD). The aim of our study was to assess whether GC use in patients diagnosed with GCA causes a decrease in BMD and if so, is it worse in the spine or the hip. Our study showed that patients with the same age and sex diagnosed with GCA using GC have a lower BMD than controls at the right femoral neck, left total hip and right total hip, after adjusting for height and weight. This suggests that overall GC is associated with lower hip BMD. These findings are important to clinicians as it gives guidance surrounding bone protection in patients with GCA using GC. These results can also be useful for future research to investigate the incidence of fractures in patients diagnosed with GCA taking GC. The results of this study along with any future research can help improve management and long term outlook in patients.

Background: There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV).Methods: All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNAþ, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA-was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV.Results: Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/ HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26).

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