Vitamin D Deficiency among HIV Type 1-Infected Individuals in the Netherlands: Effects of Antiretroviral Therapy

Abstract

Vitamin D regulates bone metabolism but has also immunoregulatory properties. In HIV-infected patients bone disorders are increasingly observed. Furthermore, low 1,25(OH)(2)D(3) levels have been associated with low CD4(+) counts, immunological hyperactivity, and AIDS progression rates. Few studies have examined the vitamin D status in HIV-infected patients. This study will specifically focus on the effects of antiretroviral agents on vitamin D status. Furthermore, the effect of vitamin D status on CD4 cell recovery after initiation of HAART will be evaluated. Among 252 included patients the prevalence of vitamin D deficiency (<35 nmol/liter from April to September and <25 nmol/liter from October to March) was 29%. Female sex, younger age, dark skin, and NNRTI treatment were significant risk factors in univariate analysis, although in multivariate analyses skin pigmentation remained the only independent risk factor. Median 25(OH)D(3) levels were significantly lower in white NNRTI-treated patients [54.5(27.9-73.8) nmol/liter] compared to white PI-treated patients [77.3 (46.6-100.0) nmol/liter, p = 0.007], while among nonwhites no difference was observed. Both PI- and NNRTI-treated patients had significantly higher blood PTH levels than patients without treatment. Moreover, NNRTI treatment puts patients at risk of elevated PTH levels (>6.5 pmol/liter). Linear regression analysis showed that vitamin D status did not affect CD4 cell recovery after initiation of HAART. In conclusion, 29% of the HIV-1-infected patients had vitamin D deficiency, with skin color as an independent risk factor. NNRTI treatment may add more risk for vitamin D deficiency. Both PI- and NNRTI-treated patients showed higher PTH levels and might therefore be at risk of bone problems. Evaluation of 25(OH)D(3) and PTH levels, especially in NNRTI-treated and dark skinned HIV-1-infected patients, is necessary to detect and treat vitamin D deficiency early.

Risk factors associated with hypovitaminosis D in HIV/aids-infected adults

“…In the study by Van Den Bout -Van Den Beukel and cols. (27) female individuals presented higher risk of hypovitaminosis D in an univariate analysis, although this finding was not confirmed by the multivariate analysis of the same study.…”

High-dose Vitamin D3 Supplementation in Children and Young Adults with HIV

“…Decreases in PTH with vitD 3 supplementation in HIV-infected subjects have been reported, 33;42 but not consistently, 42;43 and may be associated with specific anti-retroviral therapy (i.e., tenofovir). 43;44 In order to assess the full magnitude of potential efficacy, more sensitive and specific adherence measures to both supplement and HIV treatment are needed.…”

The effect of cholecalciferol supplementation on vitamin D levels and insulin sensitivity is dose related in vitamin D‐deficient HIV‐1‐infected patients

“…25(OH)D 3 was measured using high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection as described previously [1]. 1,25(OH) 2 D 3 was measured using a radioreceptor assay (RRA) after chromatographic pre-purification as described previously [16].…”

“…The vitamin D receptor (VDR) has also been found on adipocytes, suggesting a role for vitamin D in fat metabolism [7]. Indeed, it was demonstrated in vitro that 1,25-dihydroxy vitamin D 3 [1,25(OH) 2 D 3 ] inhibits adipocyte differentiation through, among other effects, inhibition of peroxisome proliferator-activated receptor-g (PPAR-g) [7][8][9]. However, 1,25(OH) 2 D 3 can elicit a nongenomic action on adipocytes in vitro, resulting in increased intracellular calcium levels and corresponding stimulation of adipogenesis and inhibition of lipolysis [10].…”