Vitamin D and bone loss in HIV

Abstract

Purpose of review Bone health has become an increasingly important aspect of the care of HIV-infected patients as bone loss with antiretroviral therapy (ART) initiation is significant and osteopenia and osteoporosis are highly prevalent. Vitamin D is tightly linked to calcium balance and bone health and vitamin D deficiency is common in HIV. This review outlines the epidemiology of vitamin D deficiency in HIV, summarizes our current understanding of the relationship between vitamin D and bone loss in HIV and the impact of vitamin D supplementation in this patient group. Recent findings While data are conflicting as to whether vitamin D deficiency is more prevalent among HIV-infected individuals than in the general population, there are several reasons for why this patient group may be at heightened risk. Studies linking vitamin D deficiency to bone loss in HIV are limited; however, data from randomized clinical trials suggest a benefit of vitamin D supplementation for the prevention of bone loss with ART initiation and for the treatment of bone loss with bisphosphonate therapy. Summary There are too limited data to recommend universal screening of vitamin D status or supplementation to all HIV-infected individuals. However, testing 25-hydroxyvitamin D levels in those at risk for deficiency and treating patients found to be deficient or initiating antiretroviral therapy or bisphosphonate therapy should be considered. Further study on vitamin D supplementation is needed regarding the potential benefit on immune activation and restoration in this patient group.

Lifetime and recent alcohol use and bone mineral density in adults with HIV infection and substance dependence

“…[29,30] Other risk factors for decreased BMD prevalent in PLWH include: vitamin D deficiency, [31,32] physical inactivity, [33] alcohol use, [23] opioid use, [6,34–36] and cocaine use. [5] …”

HIV-AIDS and Aging: Challenges and Management

“…Both HIV infection and ART treatment have been shown to be linked with the vitamin D deficiency and fragility of bones, though enough data to support this notion is lacking [30]. Similar observations have been reported to be prevalent in countries with resource-limited settings [31].…”

The Hidden Burden of Fractures in People Living With HIV

“…In addition, HIV + men may have low testosterone levels, and the frequency of hypogonadism is increased in people living with HIV . There is also an increased prevalence of vitamin D deficiency when compared to the general population, possibly due to the presence of several risk factors for vitamin D deficiency, including the use of efavirenz (a non‐nucleoside reverse transcriptase inhibitor) or protease inhibitors, anticonvulsant therapy, kidney disease, and liver disease …”

“…(73,74) In addition, HIV þ men may have low testosterone levels, (75) and the frequency of hypogonadism is increased in people living with HIV. (64,76) There is also an increased prevalence of vitamin D deficiency when compared to the general population, (65,66) possibly due to the presence of several risk factors for vitamin D deficiency, including the use of efavirenz (a non-nucleoside reverse transcriptase inhibitor) (77) or protease inhibitors, (65,78) anticonvulsant therapy, kidney disease, and liver disease. (66) Factors specifically associated with HIV are the presence of chronic inflammation, (55) reconstitution syndrome, (55) the use of ART, (8,15,20,27) co-infection with hepatitis B (79) or C, (33,80,81) low CD4, (31,32,38,81) or an AIDS-defining disease.…”