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Racial Differences in Bioavailable Vitamin D and Response
to Supplementation: A5280 ...... Bone, Vit D, EFV+Truvada & Blacks
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Reported by Jules Levin
CROI 206 Feb 22-24 Boston
Michael T Yin1, Ellen S Chan2, Todd T Brown3, Pablo Tebas4, Grace A McComsey5, Kathy Melbourne6, Royce Hardin7, Heather J Ribaudo2, E. Turner Overton8
1Columbia University, 2Harvard Chan School of Public Health, 3Johns Hopkins University, 4University of Pennsylvania, 5Case Western Reserve University, 6Gilead Sciences, Inc., 7Duke University, 8University of Alabama-Birmingham
In patients starting EFV+Truvada, daily high-dose Vit D+Calcium supplements increased vitamin D levels & reduced loss in BMD generally seen at 2-6% when starting EFV+Truvada, although there still was a little loss in BMD - see 2 graph below, this was reported at CROI/2014: http://www.natap.org/2014/CROI/croi_50.htm
At this CROI 2016 researchers from the same study report: "Despite a median total 25OHD in the insufficient range (<30ng/ml) among blacks, they had higher bioavailable 25OHD at baseline, similar PTH levels, and greater increases in bioavailable 25OHD with VitD/Ca supplementation than non-blacks......These data suggest that total 25OHD levels do not uniformly indicate vitamin D deficiency....Measurement of PTH and calculation of bioavailable 25OHD may help to elucidate racial differences in calciotropic hormone physiology and help determine whether supplementation is truly indicated
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A 2% to 6% drop in bone mineral density (BMD) when people start antiretroviral therapy is a well-documented phenomenon and is especially concerning in people with other bone risk factors and those starting tenofovir. Efavirenz has been linked to lower vitamin D, essential for healthy bones. Plentiful research documents low vitamin D levels in people with HIV and in the general population. Daily high-dose vitamin D and calcium supplements reduced total hip bone loss 50% in a 48-week placebo-controlled trial that enrolled people starting efavirenz plus tenofovir/emtricitabine [1]. The 165-person ACTG A5280 trial left open questions about the vitamin D dose used and whether calcium is an essential part of the regimen.
CROI 206 Feb 22-24 Boston
Michael T Yin1, Ellen S Chan2, Todd T Brown3, Pablo Tebas4, Grace A McComsey5, Kathy Melbourne6, Royce Hardin7, Heather J Ribaudo2, E. Turner Overton8
1Columbia University, 2Harvard Chan School of Public Health, 3Johns Hopkins University, 4University of Pennsylvania, 5Case Western Reserve University, 6Gilead Sciences, Inc., 7Duke University, 8University of Alabama-Birmingham
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