Higher vitamin D levels in HIV‐infected out‐patients on treatment with boosted protease inhibitor monotherapy

Abstract

ObjectivesWe investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. MethodsFor this cross-sectional study, out of 450 HIV-infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured ResultsThe percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty-nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL Յ 50 HIV-1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs. Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2-94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13-4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25-8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10-7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01-0.6; P = 0.018). ConclusionsOur data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.

Vitamin D and HIV Infection

“…Our group has investigated the relationship between ART and vitamin D status [51]. Similar to the study by Monet [52], our data confirm that ART based on boosted PI monotherapy has a lower risk for vitamin D deficiency.…”

Vitamin D and bone loss in HIV

“…The variance is due to different cutoffs used to define deficiency, locations at different latitudes or varying proportion of participants with dark skin, advanced immunodeficiency or antiretroviral therapy (ART) use. In recent publications, the prevalence of 25(OH)D < 30 ng/mL in HIV-infected adults mostly ART-treated was 72% in Spain(20), 71% in Thailand(21*), 70% in the US(2), 54% in Australia(22*), 24% in one study in Brazil(23*) and 83% in another(24). In ART-naïve HIV-infected adults, 59% had 25(OH)D levels < 20 ng/mL in London(25).…”

An update on the association of vitamin D deficiency with common infectious diseases

“…In a randomized, double-blind, phase 3 trial, HIV patients who received efavirenz had significantly lower 25(OH)D levels at 48 weeks compared to those who received rilpivirine (-2.5 ng/mL; P < 0.0001 vs. no change) (Wohl et al 2014). In contrast, boosted protease inhibitor monotherapy appears to causes less risk for developing vitamin D insufficiency or deficiency (Cervero et al 2013). HIV-infected individuals not on ART were recently shown to have cathelicidin levels significantly lower than HIV-negative controls (P = 0.045) and HIV-positive patients on ART (P = 0.045) (Honda et al 2014).…”