Hypocalcaemia in HIV infection and AIDS

Abstract

. Objectives. To study the prevalence and possible mechanisms of hypocalcaemia in HIV infection and AIDS. Subjects. 828 patients with HIV infection or AIDS and 549 controls. Interventions. Measurements of total serum calcium and albumin levels. Parameters of calcium homeostatsis were determined in a subgroup of 21 hypocalcaemic AIDS patients. Results. Mean serum calcium was 2.34 ± 0.13 mmol L−1 in the HIV group vs. 2.46 ± 0.10 mmol L−1 in controls (P < 0.0001). After adjusting for serum albumin, hypocalcaemia was present in 6.5% of the HIV group vs. 1.1% of controls. Mean serum calcium was declining according to CDC groups, and differed significantly from controls in each group. Regression coefficients of cacium vs. albumin were 0.147 amongst HIV‐infected patients and 0.106 for controls. In the subgroup of hypocalcaemic patients with AIDS, 10/21 had vitamin D deficiency, six of these with low ionized calcium levels. Low serum PTH was found in 2/21 patients, Magnesium deficiency in 1/21. Of the remaining eight patients, only one had secondary hyperparathyroidism, while the other seven lacked an adequate PTH response, despite low ionized calcium levels in four subjects. Conclusions. Mean serum calcium concentrations were lower through all CDC stages, irrespective of albumin, resulting in a higher prevalence of hypocalcaemia in HIV‐positive patients compared with controls. In a considerable number, this seems to be caused by vitamin D deficiency and potentially a lack of adequate PTH secretion, but further studies are needed to confirm this.

Changing Electrolyte and Acido-Basic Profile in HIV-Infected Patients in the HAART Era

“…Incidence of low levels of 1,25-(OH) 2 D in HIV patients is also reported in a recent study showing that mean serum calcium concentrations are lower in all CDC stages, irrespective of albumin. A lack of adequate parathormone secretion was suggested in these patients, but needs further confirmation in a group of 21 patients [28]. Since only a few patients received tenofovir as part of HAART, no specific correlation with plasma phosphate levels was possible in this study.…”

Tenofovir-induced renal tubular dysfunction presenting with hypocalcaemia

“…9 Hypoparathyroidism has been reported in HIV infection as has an inadequate PTH response to hypocalcaemia, i.e. normal PTH despite low levels of ionised calcium, 6 as was found in the patient described. The mechanism for this inadequate response is unclear but it has been suggested that the parathyroid expresses a CD4 like receptor and so may be vulnerable to HIV infection.…”

Vitamin D deficiency in HIV-infected patients: a systematic review

“…Of the remaining (43 papers), 30 articles reported original data with the pre-specified 25OHD cut-off values and were included in the review (Table 1). 6,[8][9][10]60 One study describing the prevalence of vitamin D deficiency in a subgroup of 21 patients with hypocalcemia and ten articles reporting 25OHD status with different cut-off levels were considered only to retrieve information about predictors of vitamin D status, 7,[48][49][50][51][52][53][54][55][56][57] and two duplicate publications were reviewed for additional data not presented in the original study. 42,58,59 Studies' characteristics…”

“…7,8,36,[39][40][41][42][43][44][45]47,48,50,51 None of these was a casecontrol study comparing the frequency of this condition between HIV+ and healthy controls. The reported frequency of sHPTH at baseline varied from 0% to 33%.…”