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

Abstract

Advances in the diagnosis and management of human immunodeficiency virus (HIV) have resulted in a dramatic decrease in mortality in HIV-infected individuals (HIV+). The subsequent increase in life expectancy of HIV+ has led to the need to consider the long-term complications of the disease and its treatment. Abnormalities in vitamin D status and metabolism are increasingly recognized as a major concern in HIV infection. In the last 5 years a number of cross-sectional and prospective studies have suggested a high prevalence of vitamin D deficiency in HIV+. Although few case-control studies have been published, it has been suggested that the prevalence of hypovitaminosis D in HIV+ is higher than in the general population, and at least in part, is related to the course of the disease and/or the antiretroviral drugs used to treat the disease. An adequate vitamin D status is important not only for bone tissue, but also for the global health status of HIV+ individuals, since a growing body of evidence has demonstrated the detrimental effects of vitamin D deficiency on multiple health outcomes. Therefore, definition of the size of the problem and identification of effective protocols for the prevention and management of vitamin D deficiency in HIV+ patients represent important steps in improving health status and reducing long-term chronic complications in individuals with HIV. Due to its immunomodulatory effects, vitamin D may also have implications in the progression of HIV infection. This systematic review was designed to determine the prevalence of vitamin D deficiency in HIV+ patients; to identify risk factors (related to the HIV infection or not) potentially associated with this condition; to describe the potential consequences of hypovitaminosis D on the course of the infection and the benefits of vitamin D repletion; and to make some suggestions about the future, considering the limitations of previous studies.

Vitamin D and HIV Infection: A Systematic Review

“…There is potentially a great improve in terms of health and well-being if serum levels of 25(OH)D3 are above 30 ng/mL [9,15]. This is particularly relevant in HIV-positive individuals in whom seems to exist a significant association between vitamin D status and HIV disease's progression and survival [2,6].…”

“…The WHO estimated an average of more than 30 million people infected with HIV in 2011 with Sub-Saharan Africa in the worst scenario [3]. The research in HIV/AIDS has led to great improvements in the prognosis of HIV-infected patients mainly after HAART [2,3]. Since its recognition, for over than 30 years, HIV infection went from a fatal diagnosis (mostly resulting in AIDS and death) to a chronic disease [2,3].…”

“…The research in HIV/AIDS has led to great improvements in the prognosis of HIV-infected patients mainly after HAART [2,3]. Since its recognition, for over than 30 years, HIV infection went from a fatal diagnosis (mostly resulting in AIDS and death) to a chronic disease [2,3]. Investigation in this area has reduced the morbidity due to HIV/AIDS complications and has made the life expectancy of infected similar to that of uninfected individuals, however the studies' samples have been insufficient to establish broad standard protocols to monitor HIV-infected patients [2,3,16].…”

“…Abnormalities in vitamin D status and metabolism might be an important concern in HIV patients, especially in those receiving Highly Active Antiretroviral Therapy (HAART). Beyond that, there seems to be evidence that antiretroviral therapy may be responsible for worsening of hypovitaminosis D [1][2][3][4].…”

“…In addition, vitamin D plays a crucial role in bone mineralization and calcium homeostasis, being essential not only to the skeletal but also to the immunologic response. It has been shown that hypovitaminosis D is more frequent among HIV-positive patients [2,3,[5][6][7]. Therefore a potential role of vitamin D in HIV-infected patients has been greatly investigated.…”