Vitamin D deficiency and insufficiency are often unappreciated in men. This cross-sectional period-prevalence study was conducted in private practice between November 20, 2008 and January 22, 2009 at latitude N 40, 46 minutes. HIV-infected men presenting for routine care without clinical disease or use of medications known to interfere with vitamin D metabolism were evaluated. Current receipt protease inhibitor (PI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were determined. Vitamin D deficiency was defined as 25-[OH] D less than 50 nmol/L, severe deficiency as less than 25 nmol/L, and insufficiency as greater than 50 nmol/L but less than 75 nmol/L. Sixty-two men, median CD4 count 541 cells per microliter, 85.5% viral load less than 200 copies per milliliter, were evaluated. A total of 30.7% were receiving a NNRTI and 59.7% a PI; 41.9% were vitamin D-deficient (11.3% severe deficiency), 33.9% insufficient, and 24.2% sufficient, p = < 0.0001. Median vitamin D: 42.4 versus 64.9 nmol/L NNRTI and PI recipients, respectively, p = 0.0017. Percentage deficient: 73.7 (14/19) NNRTI versus 29.7 (11/37) PI recipients, p = 0.0017 OR 6.62 (95% confidence interval [CI] 1.91-22.89). Tobacco use correlated with severe deficiency, p = 0.032. In conclusion, vitamin D deficiency and insufficiency were highly prevalent in these urban men irrespective of stable viral suppression. NNRTI receipt and tobacco use may be associated with lower vitamin D levels and greater risk of deficiency, and severe deficiency, respectively.

Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m(2)) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.

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Anal squamous cell carcinoma (SCC) is the fourth most prevalent cancer in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). Human papillomavirus (HPV) has been detected in over 90% of anal carcinoma biopsy specimens from MSM, and is considered a necessary, but alone, insufficient factor for carcinogenesis. Anal intraepithelial neoplasia (AIN) may be precursive for SCC, and screening cytology with referral of persons with abnormality for high-resolution anoscopy-guided biopsy, and AIN treatment, has been recommended for prevention. In the absence of either randomized controlled trials or surveillance data demonstrating a reduction in anal SCC incidence, these recommendations were based on analogy with cervical cancer. HPV-mediated genetic changes associated with cervical cancer, and aneuploidy, have been documented in AIN. However, little data exist on the rate of AIN progression to SCC. The treatment of AIN is frequently prolonged and not curative, and if routinized in the care of HIV-infected MSM, would likely be recurring well into their sixth decade of life. Clinical trials demonstrating a reduction in invasive anal carcinoma incidence, as well as acceptable morbidity with repeated AIN destruction, are needed before asking our patients to commit to routine treatment.

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