Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients

Abstract

There are no data about the optimal supplementation therapy in HIV-infected patients with vitamin D (25OHD) deficiency. The aim of this study was to assess the effect of an oral monthly dose of 16,000 IU calcidiol. We performed a longitudinal cohort study of 365 HIV-infected patients (24 % females) was with sequential determinations of 25OHD, serum parathyroid hormone (PTH), calcium, and alkaline phosphatase. The efficacy and safety of supplementation in 123 patients were compared against dietary and sun exposure advice. Overall, mean baseline 25OHD levels were 19.1 ng/ml (IQR 12-23.6), 63 % of patients had 25OHD deficiency and 27 % secondary hyperparathyroidism. After a median time of 9.3 months (95.61 patients-year on-treatment), 25OHD levels increased in comparison with non-supplemented patients (+16.4 vs. +3.2 ng/ml; p < 0.01), decreasing the rate of 25OHD deficiency (from 84 to 24 %), and decreasing serum PTH (-4.9 pg/ml) and the rate of secondary hyperparathyroidism (from 43 to 31 %; p < 0.001). This improvement was observed irrespective of HIV/HCV coinfection or the use of efavirenz. In a regression analysis, adjusting by seasonality, a lower baseline 25OHD was associated with persistence of deficiency (relative risk, RR 1.07; 95 % CI 1.03-1.1; p < 0.001), whereas calcidiol supplementation was the only factor associated with significant improvement (RR 0.38; 95 % CI 0.12-0.46; p < 0.001). This monthly dose showed no clinical toxicity, and no patient had 25OHD levels above 100 ng/ml, nor hypercalcemia. The use of monthly calcidiol is safe, easy to take, and largely effective to improve vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.

Bone health and HIV in resource-limited settings

“…According to a recent review by Mansueto et al [ 96 ] the prevalence of vitamin D deficiency among HIV-infected individuals in both RLS and RRS varies widely across studies ranging from 25 to 93%, with an overall prevalence of 70.3 to 83.7%. Similarly, our review yielded high but similar prevalence of low vitamin D among HIV individuals regardless of ART use in both RLS [ 50 , 53 , 97 – 102 ] and RRS [ 61 , 103 – 109 ] with insufficient levels of up to 90% in Turkey [ 50 ] and the USA [ 103 ], Belgium [ 108 ], Spain [ 109 ] (Table 2 and Fig. 2 ).…”

Effects of cholecalciferol supplementation on serum and urinary vitamin D metabolites and binding protein in HIV-infected youth

“…Other ART-initiation and switch studies have shown similar results [37, 61–63], suggesting that perhaps higher repletion doses in HIV-subjects on EFV compared to those not on EFV are necessary. However, the supplementation studies that have evaluated changes in 25(OH)D or percentage of subjects reaching optimal 25(OH)D concentrations in ART-stable subjects have not shown any differences between those on or not on EFV [44, 46, 57]. Our current findings support this idea that once an individual is stable on an EFV-based regimen, no difference in repletion doses are necessary.…”

Change in serum 25-hydroxyvitamin D with antiretroviral treatment initiation and nutritional intervention in HIV-positive adults

“…Serum 25(OH)D increased slightly in the supplemented patients, and declined in those not given a supplement. Other studies among HIV patients have also shown an increase in serum 25(OH)D with vitamin D supplementation (12,13,32,33) . Longitudinal studies in HIV patients without vitamin D supplementation (34,35) have reported a decrease in serum 25(OH)D with ART initiation as observed in our study.…”