Vitamin D and Osteoporosis in HIV/HCV Coinfected Patients: A Literature Review

Abstract

Vitamin D deficiency further increases the risk of osteoporosis in HIV-positive patients coinfected with hepatitis C virus (HCV); however, it is still unclear whether HCV-related increased fracture risk is a function of the severity of liver disease. The aim of this review was to identify studies on associative vitamin D deficiency patterns in high-risk populations such as HIV/HCV coinfected patients. We did this by searching MEDLINE and EMBASE databases, from inception to August 2014, and included bibliographies. The final 12 articles selected are homogeneous in terms of age but heterogeneous in terms of sample size, participant recruitment, and data source. Most of the HIV/HCV coinfected patients have less than adequate levels of vitamin D. After reviewing the selected articles, we concluded that vitamin D deficiency should be regarded as a continuum and that the lower limit of the ideal range is debatable. We found that vitamin D deficiency might influence liver disease progression in HIV/HCV coinfected patients. Methodological issues in evaluating vitamin D supplementation as a relatively inexpensive therapeutic option are discussed, as well as the need for future research, above all on its role in reducing the risk of HCV-related fracture by modifying liver fibrosis progression.

A vitamin D protocol post‐liver transplantation

“…of the main causes of liver disease and increases the risk of developing HCC by 2-6% per year (Oliviera-Andrade et al, 2009). Recent in vitro studies have shown that VD acts as an antiviral agent that inhibits HCV production in a human hepatoma cell line (DiCarlo et al, 2015). In patients with HCV that underwent liver transplantation with subsequent recurrent HCV, high rates of sustained virologic response were noted in patients receiving VDS (Abu-Mouch et al, 2011;Bitetto et al, 2011;Iruzubieta et al, 2014).…”

“…Vitamin D (VD) has a number of pleiotropic effects including anti-inflammatory properties; antiapoptosis; antifibrosis; regulation of function in the kidney, heart, and immune system; and it maintains homeostasis by regulation of hormone secretion, cell proliferation, and differentiation (Lai & Fang, 2013). Research outlines the merits of VD supplementation (VDS) in patients with chronic liver disease (CLD) of various etiologies (Anty et al, 2014;DiCarlo et al, 2015;Eliades & Spyrou, 2015;Fernandez-Fernandez, Linares-Torres, Matias, Jorquera-Plaza, & Olcoz-Goni, 2015). Cited benefits can be stratified into areas such as the immune system (innate and adaptive), bone health, and all-cause mortality (Iruzubieta, Teran, Crespo, & Fabrega, 2014;Stokes, Volmer, Grunhage, & Lammert, 2013;Villar, Del Campo, Ranchal, Lampe, & Romero-Gomez, 2013).…”

Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture

“…However, it remains unclear whether lower vitamin D levels are associated with either decreased bone mineral density or increased fracture risk in the setting of HIV/HCV co-infection [49]. …”

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

“…Carlo et al concluded that vitamin D deficiency might influence liver disease progression in HIV/HCV-coinfected patients [ 58 ]. Another possible mechanism is the interaction between inflammation caused by the two viruses and the immune system, which may lead to upregulation of the receptor activator of the nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) pathways and, hence, bone resorption, in addition to bone toxicity, as a result of the use of TDF or protease inhibitors to virologically suppress both HBV and HIV infections [ 59 ]. It worth mentioning, that eradication of HCV is not associated with improvement in BMD [ 60 ].…”