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Highly prevalent vitamin D deficiency and insufficiency among an urban cohort of human immunodeficiency virus (HIV)-infected men under care
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Reported by Jules Levin
5th IAS Capetown July 19-22 2009
from Jules: This study was conducted at private practice clinic in Queens New York, patients are largely employed and under private care, "unlikely to be experiencing effects of socioeconomic marginality or food insecurity. 84% had undetectable viral load". 75% of patients had inadequate 25-[OH] vitamin D levels - 42% deficient (<50 nmol/L) & 34% insufficient (betw 50-75 nmol/L), 11.3% were severely deficient (<25 nmol/L). There were highly significant differences between PI & NNRTI recipients median vitamin D levels with NNRTI recipients 6 fold more likely to demonstrate deficiency. Median vitamin D levels were lower for patients on NNRTIs vs PIs (42.4 nmol/l vs 64.9 nmol/L (p=0.0017). 73% (14/19) on NNRTIs vs 29.7% on PIs were vitamin D deficient (p=0.0017) OR 6.62. The authors said: "our findings, the association of NNRTI receipt with lower median serum 25-[OH] vitamin D and deficiency, are consistent with NNRTI effect on vitamin D metabolism....our findings suggest that periodic screening of vitamin D, and supplementation as needed, should be considered in the routine care of HIV-infected men."
D. Rubin1,2, P. Wasserman1
1New York Hospital Queens, Infectious Disease Division, Department of Medicine, New York, United States, 2Weill Cornell Medical College, New York, United States
Background: Inadequate vitamin D may contribute to chronic disease. We investigated serum Vitamin D levels of men under care.
Methods: Prospective period prevalence study, November 20, 2008 to January 22, 2009, conducted in private practice at latitude N 40, 46 minutes. Men presenting for routine follow-up without clinical disease or use of medications known to interfere with vitamin D metabolism were evaluated. Age, ethnicity, HIV risk factor, history wasting, tobacco/vitamin use, time since diagnosis HIV infection and initiation combination antiretroviral therapy (cART), current receipt: protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI) were determined. Nutriture was evaluated by body mass index (BMI) and mid-upper arm circumference (MUAC). Serum 25-[OH] vitamin D, CD4 cell count and viral load (VL) were assayed. Vitamin D deficiency was defined as < 50 nmol/L (20ng/dl), severe deficiency < 25 nmol/L (10ng/dl) and insufficiency > 50 nmol/L but < 75 nmol/L (30 ng/dl).
Results:
62 men, 77% MSM, 91.9% receiving cART (91.2% VL < 200), 46.8% Hispanic, 33.9% white, 16.1% black, 30.7% receiving NNRTI and 59.7% PI.
Median: age 48 years, BMI 26.4, MUAC percentile 25, time since diagnosis 12 years, duration cART 9 years, CD4 541(25%) 0.63. VL < 200 83.9%.
Overall, 41.9 % vitamin D deficient (11.3% severe deficiency), 33.9% insufficient and 24.2% sufficient, P= < 0.0001.
Median vitamin D: 42.4 versus 64.9 nmol/L NNRTI and PI recipients, respectively, P = 0.0017.
Deficient %: 73.7 (14/19) NNRTI versus 29.7 (11/37) PI recipients, P=0.0017 OR 6.62 (95% CI 1.91-22.89).
Tobacco use correlated with severe deficiency P=0.032.
There were no correlations with ethnicity, history wasting, current CD4 or nutritional parameters.
Conclusions: Vitamin D deficiency and insufficiency were highly prevalent among asymptomatic HIV-infected men receiving cART. Routine clinical screening may be of value. NNRTI receipt may be associated with deficiency and is an area for future research.
Highly prevalent vitamin D deficiency and insufficiency among an urban cohort of HIV-infected men under care
David S. Rubin and Peter Wasserman
Infectious Disease Division, Department of Medicine, New York Hospital Queens, New York City, USA
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