In our pts treatment with tenofovir (13/26) showed no evidence of these side effects: five pts

with an increased PTH showed no increased loss of urinary phosphate. The higher WFH score in co-infected and mono-infected pts, than in the uninfected, could suggest an association with the infections (Fig. 1). However Y-27632 these two groups had a higher prevalence of pts with severe haemophilia A (Table 1), which may also have played a role in the development of arthropathy with consequent disability. The severity of the inherited bleeding disorder rather than the addition of a co-infection seemed to have a more significant role regarding the global clinical functionality of haemophilic pts. The higher Pettersson score in mono-infected pts alone was unexpected. In our results five of 26 mono-infected pts compared with two of 26 co-infected and two of 26 uninfected pts showed high-responding inhibitors. These pts

have recurrent episodes of bleeding that are difficult to manage and lead to early joint damages [24]. The higher Pettersson score in mono-infected pts could be explained by the higher number of pts with high-responding inhibitors leading to a more severe arthropathy. This theory is supported by the number of total knee arthroplasty performed in this group (8/26 pts) vs. 3/26 and 2/26, respectively, in co-infected and uninfected groups. The presence of higher Pettersson score in pts treated with secondary prophylaxis than those treated on demand reveals that those receiving secondary prophylaxis have more frequent bleeding episodes. A global reduction Cabozantinib manufacturer of BMD in studied population was observed. The F DXA reflects the BMD of cortical bone, which is responsible for most support functions. The L DXA represents the BMD of trabecular bone, mainly Glycogen branching enzyme involved in the maintenance of mineral homeostasis. The BMD pattern for F DXA was similar in the three studied groups. This result could be explained by the

pivotal role of the arthropathy, irrespective of infection, in determining the BMD reduction at this particular site, because of loss of joint function with reduced mobility, due to recurrent haemarthrosis [25, 26]. Haemophilic children may never obtain the peak bone mass reached by comparable healthy boys, because weight-bearing activity during youth is the most important factor for peak bone mass [2, 3]. In haemophilic adults, with an increase of severity and number of haemarthroses, BMD is significantly decreased [1, 4]. The L BMD was found to be significantly lower in co-infected group than in uninfected, both in terms of osteopenia and osteoporosis. This result is supported by the concept that high bone turnover states, such as in HIV-infected pts, involve trabecular bone earlier and to a greater extent than the cortical bone [27].