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HIV Infection Tied to Lower Risk of Vitamin D Deficiency in US Women's Study
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
HIV infection lowered the risk of vitamin D deficiency in the Women's Interagency HIV Study (WIHS) [1]. Almost two thirds of women in this large cohort had vitamin D deficiency, but the risk was significantly lower in WIHS women with HIV than in HIV-negative WIHS women, who are at risk of HIV. Efavirenz use predicted deficiency in women with HIV, while protease inhibitor (PI) use lowered the risk.
This cross-sectional study involved 1254 WIHS women with HIV and 506 HIV-negative WIHS women with stored serum samples collected from October 2007 through March 2008. The investigators believe this is the largest vitamin D study so far in HIV-infected adults. WIHS sites are Chicago, New York City, Washington, DC, Los Angeles, and the San Francisco Bay Area. The investigators defined vitamin D deficiency as a 25(OH)D level at or below 20 ng/mL and severe deficiency as below 10 ng/mL.
The group with HIV was older than the group without HIV (median 44.4 versus 41.3 years, P < 0.001), included a nonsignificantly smaller proportion of blacks (59% versus 64%, P = 0.07), and included a significantly larger proportion of women with hepatitis C virus (HCV) antibody (28% versus 19%, P < 0.001). A smaller proportion of women with HIV were employed (38% versus 49%, P < 0.001). Median body mass index was significantly lower in the HIV-positive group (27.8 versus 30.1 kg/m(2), P < 0.001). (People with a body mass index between 25 and 29.9 are considered overweight, and those above 29.9 are considered obese.) Median CD4 count among women with HIV was 459 (interquartile range 295 to 662).
Two thirds of all women (66%) had vitamin D deficiency, and 22% had severe deficiency. Significantly fewer women with HIV than without HIV (62% versus 75%, P < 0.001) had vitamin D deficiency. A multivariate model that factored in numerous vitamin D deficiency risk factors identified several that independently raised or lowered the deficiency risk in this population at the following odds ratios (OR) and 95% confidence intervals (CI):
Vitamin D deficiency risk in women with or without HIV
-- HIV infection: 24% lower risk (OR 0.76, 95% CI 0.59 to 0.96, P = 0.02)
-- Every additional 10 years of age: 21% lower risk (OR 0.79, 95% CI 0.70 to 0.90, P < 0.001)
-- Los Angeles versus other sites: 39% lower risk (OR 0.61, 95% CI 0.43 to 0.85, P = 0.004)
-- Chicago versus other sites: 38% lower risk (OR 0.62, 95% CI 0.43 to 0.89, P = 0.01)
-- African American: more than 3 times higher risk (OR 3.27, 95% CI 2.50 to 4.28, P < 0.001)
-- 10 kg/m(2) higher body mass index: 41% higher risk (OR 1.41, 95% CI 1.22 to 1.64, P < 0.001)
Multivariate analysis limited to women with HIV isolated the following independent risk factors:
Vitamin D deficiency risk in women with HIV
-- CD4 count 50-200 versus higher: 60% higher risk (OR 1.60, 95% CI 1.07 to 2.37, P = 0.02)
-- CD4 count under 50 versus above 200: 94% higher risk (OR 1.94, 95% CI 1.12 to 2.36, P = 0.02)
-- Current efavirenz use: 64% higher risk (OR 1.64, 95% CI 1.0 to 2.7, P = 0.05)
-- Current PI use: 34% lower risk (OR 0.66, 95% CI 0.48 to 0.91, P = 0.01)
Every 10 kg/m(2) higher body mass index was associated with an average 0.09-log lower vitamin D level. In the same analysis a CD4 count of 50-200 (versus higher) correlated with an average 0.14-log lower vitamin D concentration, a CD4 count under 50 correlated with an average 0.20-log lower level, efavirenz use correlated with an average 0.24-log lower level, and current PI use correlated with an average 0.12-log higher level.
Some earlier studies made the same link between efavirenz use and low vitamin D. But in an International AIDS Conference study reported separately by NATAP, neither efavirenz nor any other antiretroviral raised the risk of vitamin D deficiency in a London study group [2].
References
1. Adeyemi OM, Agniel D, French A, et al. High rates of vitamin D deficiency among HIV-infected at at-risk women in the United States. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPDB101.
2. Rashid T, Devitt E, Mandalia S, et al. No association of vitamin D levels with individual antiretroviral agents, duration of HIV-infection, alkaline phosphatase levels nor bone mineral density findings. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPDB105.
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