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Vitamin D Deficiency in HCV/HIV-Coinfected People in the UK
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Tenth International Congress on Drug Therapy in HIV Infection, November 7-11, 2010, Glasgow
Mark Mascolini
Vitamin D deficiency was associated with kidney function and spleen size in UK patients coinfected with HIV and hepatitis C virus (HCV) [1]. But deficiency proved statistically equivalent in HCV/HIV-infected people and matched controls infected only with HIV, and very few people in either group had severe deficiency.
This multicenter cross-sectional comparison involved 195 HCV/HIV-infected people and 128 people infected only with HIV who were matched to the coinfected group by gender and ethnicity. The investigators defined severe deficiency as a 25OHD level below 10 ug/L, deficiency as below 20 ug/L, and a suboptimal level as below 30 ug/L. The analysis excluded people taking vitamin D supplements.
Most cohort members (90%) were men, 86% were white, 7% were black, and 18% became infected with HIV through injection drug use.
Prevalence of vitamin D deficiency was 12% in the HCV/HIV group and 21% in the HIV group, a nonsignificant difference (P = 0.876). Vitamin D concentrations averaged 50 nmol/L (range 10 to 137) in the coinfected group and 46 nmol/L (range 11 to 168) in the HIV-only group, also a nonsignificant difference (P = 0.396). (To convert nmol/L to ng/mL, divide by 2.5.) Respective parathyroid hormone concentrations averaged 49 and 36 units.
Among the 195 HCV/HIV-coinfected people, 40% had a 25OHD level below 30 ug/L (suboptimal), 12% had a level below 20 ug/L (deficient), and 2% had a level below 10 ug/L (severely deficient).
A multivariate model to explore associations between vitamin D deficiency, parathyroid hormone, and HCV status considered gender, ethnicity, and season of sampling for vitamin D measurement. Only two variables considered were associated with low vitamin D levels: estimated glomerular filtration rate (eGFR, confidence interval -1.048 to -0.333, P = 0.038) and spleen size (confidence interval -14.00 to -2.589, P = 0.006). Variables that did not affect vitamin D concentrations included gender, age, ethnicity, winter season, parathyroid hormone, CD4 count, antiretroviral status, use of tenofovir or efavirenz, Fibroscan score, liver fibrosis on biopsy, HCV status, or HCV load.
The investigators from Guy's and St. Thomas' Hospital and Brighton and Sussex University Hospital cautioned that the significance of the associations between vitamin D deficiency and eGFR and spleen size must be confirmed in further study.
Previous research by other investigators found that vitamin D supplementation improves sustained virologic response to pegylated interferon plus ribavirin in previously untreated people with HCV genotype 1 [2].
Reference
1. Surah S, Samarawickrama A, Campbell L, et al Prevalence and factors associated with severe vitamin D deficiency in HIV/hepatitis C co-infected persons. Tenth International Congress on Drug Therapy in HIV Infection. November 7-11, 2010. Glasgow. Abstract P103.
2. Abu Mouch S, Fireman Z, Jarchovsky J, Assy N. Vitamin D supplement improve SVR in chronic hepatitis C (genotype 1) naive patients treated with peg interferon and ribavirin. 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010). April 14-18, 2010. Vienna. http://www.kenes.com/easl2010/Orals/204.htm.
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