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Belete AM, Tefera AA, Getnet M, Asefa A, Aynalem YA, Shiferaw WS. Prevalence and Predictors of Hypovitaminosis D in Ethiopian HIV-Infected Adults. HIV AIDS (Auckl) 2021; 13:1101-1109. [PMID: 34992468 PMCID: PMC8710583 DOI: 10.2147/hiv.s345827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hypovitaminosis D is associated with bone fracture and cardiovascular disease in patients receiving antiretroviral therapy. Currently, there are few data on the magnitude of hypovitaminosis D in people living with HIV in Sub-Saharan country. Therefore, the present study determines the magnitude of hypovitaminosis D in people living with HIV and its associated factors in Ethiopia. Methods A cross-sectional study was conducted among 171 adult people living with HIV at Debre Berhan Specialized Hospital. Serum vitamin D was measured. Multivariate logistic regression analysis and p-value <0.05 was used to identify the associated factors of hypovitaminosis D. Results In the present study, the prevalence of hypovitaminosis D was 129/171 (75.4%), with 11/171 (6.4%) having vitamin D deficiency and 118/171 (69%) having vitamin D insufficiency. Female sex was significantly associated with hypovitaminosis D (AOR: 3.01, 95% CI = 1.381–6.561, P = 0.006). Conclusion Our study found a high burden of hypovitaminosis D among adult people living with HIV on antiretroviral therapy. Female sex was associated with hypovitaminosis D.
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Affiliation(s)
- Abebe Muche Belete
- Biomedical Department, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Abebe Muche Belete Email
| | | | - Mekasha Getnet
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Adisu Asefa
- Biomedical Department, Debre Berhan University, Debre Berhan, Ethiopia
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Crutchley RD, Jacobs DM, Gathe J, Mayberry C, Bulayeva N, Rosenblatt KP, Garey KW. Vitamin D Assessment Over 48 Weeks in Treatment-Naive HIV Individuals Starting Lopinavir/Ritonavir Monotherapy. Curr HIV Res 2021; 19:61-72. [PMID: 32860360 DOI: 10.2174/1570162x18666200827115615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitamin D deficiency is common in HIV population and has been associated with increased comorbidity risk and poor immunologic status. OBJECTIVE To evaluate the effect of protease inhibitor lopinavir/ritonavir monotherapy on changes in serum 25-hydroxyvitamin D [25(OH)D] over 48 weeks. METHODS Thirty-four treatment-naïve HIV individuals initiating lopinavir/ritonavir monotherapy and receiving clinical care from private practice in Houston, Texas, were included. Serum 25-hydroxyvitamin D levels from stored plasma samples collected from IMANI-2 pilot study at both baseline and 48 weeks were analyzed using LC-MS assays. Mean 25(OH)D at baseline and 48 weeks were compared using paired t-tests. Linear regression analysis was used to evaluate factors associated with changes in 25(OH)D. Logistic regression analyses were used to determine the effect of vitamin D status and covariates on CD4 cell count recovery. RESULTS Mean 25(OH)D was significantly higher at 48 weeks (26.3 ng/mL (SD + 14.9); p=0.0003) compared to baseline (19.8 ng/mL (SD +12.1), with fewer individuals having vitamin D deficiency (41.2%) and severe deficiency (11.8%). Both body mass index and baseline CD4 cell count were significant independent covariates associated with 25(OH)D changes over 48 weeks. Baseline vitamin D status did not affect CD4 cell count recovery. However, in a 24-week multivariate analysis, current tobacco use was significantly associated with a decreased odds of CD4 cell count recovery (AOR 0.106, 95% CI 0.018-0.606; p=0.012). CONCLUSION Individuals treated with lopinavir/ritonavir monotherapy had significantly higher 25(OH)D after 48 weeks. Current tobacco users had significantly diminished CD4 cell count recovery after starting treatment, warranting further clinical investigation.
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Affiliation(s)
- Rustin D Crutchley
- Department of Pharmacotherapy, Washington State University, College of Pharmacy and Pharmaceutical Sciences, Yakima, WA, United States
| | - David M Jacobs
- Department of Pharmacy Practice, University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, United States
| | - Joseph Gathe
- Therapeutic Concepts, Inc, Houston, TX, United States
| | - Carl Mayberry
- Therapeutic Concepts, Inc, Houston, TX, United States
| | - Nataliya Bulayeva
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kevin P Rosenblatt
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Houston, TX, United States
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Pardhan S, Smith L, Sapkota RP. Vitamin D Deficiency as an Important Biomarker for the Increased Risk of Coronavirus (COVID-19) in People From Black and Asian Ethnic Minority Groups. Front Public Health 2021; 8:613462. [PMID: 33553096 PMCID: PMC7862572 DOI: 10.3389/fpubh.2020.613462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Shahina Pardhan
- Faculty of Health, Education, Medicine and Social Care, Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- Faculty of Science and Engineering, The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Raju P Sapkota
- Faculty of Health, Education, Medicine and Social Care, Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
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Hypovitaminosis D and hyperparathyroidism: effects on bone turnover and bone mineral density among perinatally HIV-infected adolescents. AIDS 2016; 30:1059-67. [PMID: 26807972 DOI: 10.1097/qad.0000000000001032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The impact of hypovitaminosis D and secondary hyperparathyroidism on bone mineral density (BMD) in the setting of pediatric HIV infection remains unclear. This study aimed to determine the prevalence of hypovitaminosis D and hyperparathyroidism and their effects on bone turnover and BMD among HIV-infected adolescents in Southeast Asia. DESIGN A multicenter, cross-sectional study evaluating bone health and vitamin D metabolism in HIV-infected adolescents in Thailand and Indonesia. METHODS Perinatally HIV-infected adolescents aged 10-18 years on antiretroviral therapy with virologic suppression were enrolled. Serum 25-hydroxyvitamin D, intact parathyroid hormone, and bone turnover markers (C-terminal cross-linked telopeptide of type I collagen and procollagen type I amino-terminal propeptide) were assessed; serum 25-hydroxyvitamin D less than 20 ng/ml and intact parathyroid hormone more than 65 pg/ml were defined as hypovitaminosis D and hyperparathyroidism, respectively. Lumbar spine (L2-L4) BMD Z-score -2 or less was defined as low BMD. RESULTS Of 394 adolescents, 57% were women. The median age [interquartile range (IQR)] was 15.0 (13.3-16.9) years. The prevalence of hypovitaminosis D, hyperparathyroidism, and both conditions were 21% [95% confidence interval (CI): 17-25%], 17% (95% CI: 13-20%), and 5% (95% CI: 3-7%), respectively. Adolescents with hypovitaminosis D and secondary hyperparathyroidism had the highest median bone resorption (C-terminal cross-linked telopeptide of type I collagen: 1610 vs. 1270 ng/l; P = 0.04) and bone formation (procollagen type I amino-terminal propeptide: 572 vs. 330 μg/l; P = 0.02) markers, and the greatest proportion of low BMD (42 vs. 15%; P = 0.01) compared with the rest of the cohort. CONCLUSION Hypovitaminosis D complicated with secondary hyperparathyroidism was associated with increased bone turnover and bone loss. Early treatment of hypovitaminosis D before hyperparathyroidism occurs may be important to prevent bone mass deterioration.
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Canuto JMP, Canuto VMP, de Lima MHA, de Omena ALCS, Morais TMDL, Paiva AM, Diniz ET, de Almeida DJFT, Ferreira SMS. Risk factors associated with hypovitaminosis D in HIV/aids-infected adults. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:34-41. [PMID: 25926112 DOI: 10.1590/2359-3997000000007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/17/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. SUBJECTS AND METHODS This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher's exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. RESULTS The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p < 0.05). Higher vitamin D levels were associated with female gender (p < 0.001), no use of sunscreen (p < 0.05), and previous opportunistic infections (p < 0.01). Lower values were associated with the use of antiretroviral medication (p < 0.05), overweight and obesity (p < 0.01). CONCLUSION Lower vitamin D concentrations were significantly associated with well-known risk factors for hypovitaminosis D: use of sunscreen, antiretroviral medication, overweight, and obesity. The prevalence of hypovitaminosis D in this study, considering values > 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study.
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Hidron AI, Hill B, Guest JL, Rimland D. Risk factors for vitamin D deficiency among veterans with and without HIV infection. PLoS One 2015; 10:e0124168. [PMID: 25898185 PMCID: PMC4405192 DOI: 10.1371/journal.pone.0124168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/10/2015] [Indexed: 12/20/2022] Open
Abstract
Objectives We aimed to describe and compare the prevalence of vitamin D deficiency between HIV-negative and HIV-infected veterans in the southern United States, and to determine risk factors for vitamin D deficiency for HIV infected patients. Methods Cross-sectional, retrospective study including all patients followed at the Atlanta VA Medical Center with the first 25-hydroxyvitamin D [25(OH)D] level determined between January 2007 and August 2010. Multivariate logistic regression analysis was used to determine risk factors associated with vitamin D deficiency (< 20 ng/ml). Results There was higher prevalence of 25(OH)D deficiency among HIV-positive compared to HIV-negative patients (53.2 vs. 38.5%, p <0.001). Independent risk factors for vitamin D deficiency in HIV + patients included black race (OR 3.24, 95% CI 2.28–4.60), winter season (OR 1.39, 95% CI 1.05–1.84) and higher GFR (OR 1.01, CI 1.00–1.01); increasing age (OR 0.98, 95% CI 0.95–0.98), and tenofovir use (OR 0.72, 95% CI 0.54–0.96) were associated with less vitamin D deficiency. Conclusions Vitamin D deficiency is a prevalent problem that varies inversely with age and affects HIV-infected patients more than other veterans in care. In addition to age, tenofovir and kidney disease seem to confer a protective effect from vitamin D deficiency in HIV-positive patients.
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Affiliation(s)
- Alicia I. Hidron
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Emory University School of Medicine, Atlanta, Georgia, United States of America
- Universidad Pontificia Bolivariana, Medellín, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Colombia
- * E-mail:
| | - Brittany Hill
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Winship Cancer Institute at Emory University, Atlanta, Georgia, United States of America
| | - Jodie L. Guest
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Emory University School of Medicine, Atlanta, Georgia, United States of America
- Rollins School of Public Health at Emory University, Atlanta, Georgia, United States of America
| | - David Rimland
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Emory University School of Medicine, Atlanta, Georgia, United States of America
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Rai P, Singh T, Lederman R, Chawla A, Kumar D, Cheng K, Valecha G, Mathieson PW, Saleem MA, Malhotra A, Singhal PC. Hyperglycemia enhances kidney cell injury in HIVAN through down-regulation of vitamin D receptors. Cell Signal 2014; 27:460-9. [PMID: 25542307 DOI: 10.1016/j.cellsig.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/28/2014] [Accepted: 12/19/2014] [Indexed: 12/14/2022]
Abstract
In the present study, we evaluated the effect of short term hyperglycemia on renal lesions in a mouse model (Tg26) of HIV-associated nephropathy (HIVAN). Control and Tg26 mice in groups (n=6) were administered either normal saline (FVBN or Tg) or streptozotocin (FVBN+STZ or Tg26+STZ). After two weeks, biomarkers were collected and kidneys were harvested. FVBN+ STZ and Tg26+STZ displayed elevated serum glucose levels when compared to FVBN and Tg26 respectively. Tg26+STZ displayed elevated (P<0.05) blood urea nitrogen (BUN) levels (P<0.05) and enhanced (P<0.01) proteinuria when compared to Tg26. Tg26+STZ displayed enhanced (P<0.001) number of sclerotic glomeruli and microcysts vs. Tg26. Renal tissues of Tg26 displayed down regulation of vitamin D receptor (VDR) expression and enhanced Ang II production when compared to FVBN mice. Hyperglycemia exacerbated down regulation of VDR and production of Ang II in FVBN and Tg mice. Hyperglycemia increased kidney cell reactive oxygen species (ROS) production and oxidative DNA damage in both FVBN and Tg26 mice. In in vitro studies, HIV down regulated podocyte VDR expression and also enhanced renin angiotensin system activation. In addition, both glucose and HIV stimulated kidney cell ROS generation and DNA damage and compromised DNA repair; however, tempol (superoxide dismutase mimetic), losartan (Ang II blocker) and EB1089 (VDR agonist) provided protection against DNA damaging effects of glucose and HIV. These findings indicated that glucose activated the RAS and inflicted oxidative stress-mediated DNA damage via down regulation of kidney cell VDR expression in HIV milieu both in vivo and in vitro.
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Affiliation(s)
- Partab Rai
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Tejinder Singh
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Rivka Lederman
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Amrita Chawla
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Dileep Kumar
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Kang Cheng
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Gautam Valecha
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Peter W Mathieson
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Moin A Saleem
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Ashwani Malhotra
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK
| | - Pravin C Singhal
- Department of Medicine, Feinstein Institute for Medical Research, North Shore LIJ Medical School, NY, USA; Department of Pediatrics, University of Bristol, Bristol, UK.
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Escota GV, Cross S, Powderly WG. Vitamin D and calcium abnormalities in the HIV-infected population. Endocrinol Metab Clin North Am 2014; 43:743-67. [PMID: 25169565 DOI: 10.1016/j.ecl.2014.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of vitamin D deficiency among HIV-infected persons is substantial and comparable to the general population. The factors associated with vitamin D deficiency are similar for both populations but additional factors (ie, use of certain antiretroviral agents) also contribute to vitamin D deficiency among HIV-infected persons. The adverse outcomes associated with vitamin D deficiency considerably overlap with non-AIDS defining illnesses (NADIs) that are increasingly becoming widespread in the aging HIV-infected population. However, there is scant evidence to support any causal inference. Further studies are warranted as efforts to identify and address modifiable risk factors contributing to NADIs continue.
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Affiliation(s)
- Gerome V Escota
- Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA
| | - Sara Cross
- Division of Infectious Diseases, University of Tennessee Health Sciences Center, 956 Court Avenue, E336 Coleman Building, Memphis, TN 38163, USA
| | - William G Powderly
- Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA.
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Honda JR, Connick E, MaWhinney S, Chan ED, Flores SC. Plasma LL-37 correlates with vitamin D and is reduced in human immunodeficiency virus-1 infected individuals not receiving antiretroviral therapy. J Med Microbiol 2014; 63:997-1003. [PMID: 24821067 DOI: 10.1099/jmm.0.070888-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low levels of the vitamin D-regulated antimicrobial peptide cathelicidin (LL-37) may negatively impact the immune status of human immunodeficiency virus-1 (HIV-1) infected individuals (HIV+). We compared plasma LL-37 levels in healthy controls (HIV-) and HIV+ individuals on or off antiretroviral therapies (ARTs) (ART+ and ART-, respectively), and evaluated the relationship between vitamin D and LL-37 levels. In this cross-sectional study, levels of LL-37, 25-hydroxycholecalciferol [25(OH)D3] and 1,25-dihydroxycholecalciferol [1,25(OH)2D3] were measured from an initial cohort of 18 healthy controls and 10 HIV+/ART- individuals. Because this cohort lacked HIV+/ART+ subjects, LL-37 was also quantified from a second cohort of 10 HIV+/ART- and 13 HIV+/ART+ individuals. LL-37 levels were significantly lower in the HIV+/ART- group compared to the healthy controls (P = 0.01). A direct relationship was observed between LL-37 and both 25(OH)D3 and 1,25(OH)2D3. The level of 25(OH)D3 was predictive of higher LL-37 (P = 0.04) and for any given level of 25(OH)D3, HIV+/ART- subjects averaged 20 % lower LL-37 compared to the healthy controls (P = 0.045). For any given level of 1,25(OH)2D3, HIV+/ART- subjects averaged 25% lower LL-37 compared to the healthy controls (P = 0.018), although 1,25(OH)2D3 was not predictive of higher LL-37 (P = 0.28). Finally, LL-37 levels were significantly lower in the HIV+/ART- group compared to the HIV+/ART+ group from the second cohort (P = 0.045). Untreated HIV infection may contribute to lower LL-37 levels, independent of vitamin D levels. ART treatment may potentially mitigate this decrease in LL-37 levels.
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Affiliation(s)
- Jennifer R Honda
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Elizabeth Connick
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Samantha MaWhinney
- Colorado School of Public Health, Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Edward D Chan
- National Jewish Health and Denver Veterans Affairs Medical Center, Denver, CO 80220, USA
| | - Sonia C Flores
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2014; 32:250-8. [DOI: 10.1016/j.eimc.2013.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/03/2013] [Indexed: 12/20/2022]
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Shepherd L, Souberbielle JC, Bastard JP, Fellahi S, Capeau J, Reekie J, Reiss P, Blaxhult A, Bickel M, Leen C, Kirk O, Lundgren JD, Mocroft A, Viard JP. Prognostic value of vitamin D level for all-cause mortality, and association with inflammatory markers, in HIV-infected persons. J Infect Dis 2014; 210:234-43. [PMID: 24493824 DOI: 10.1093/infdis/jiu074] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Low 25-hydroxyvitamin D (25(OH)D) has been associated with inflammation, human immunodeficiency virus (HIV) disease progression, and death. We aimed to identify the prognostic value of 25(OH)D for AIDS, non-AIDS-defining events and death, and its association with immunological/inflammatory markers. METHODS Prospective 1-1 case-control study nested within the EuroSIDA cohort. Matched cases and controls for AIDS (n = 50 matched pairs), non-AIDS-defining (n = 63) events and death (n = 41), with plasma samples during follow-up were selected. Conditional logistic regression models investigated associations between 25(OH)D levels and annual 25(OH)D change and the probability of events. Mixed models investigated relationships between 25(OH)D levels and immunological/inflammatory markers. RESULTS In sum, 250 patients were included. Median time between first and last sample and last sample and event was 44.6(interquartile range [IQR]: 22.7-72.3) and 3.1(IQR: 1.4-6.4) months. Odds of death decreased by 46.0%(95% confidence interval [CI], 2.0-70.0, P = .04) for a 2-fold increase in latest 25(OH)D level. There was no association between 25(OH)D and the occurrence of AIDS or non-AIDS-defining events (P > .05). In patients with current 25(OH)D <10 ng/mL, hsIL-6 concentration increased by 4.7%(95% CI, .2,9.4, P = .04) annually after adjustment for immunological/inflammatory markers, and no change in hsCRP rate was observed (P = .76). CONCLUSIONS Low Vitamin D predicts short term mortality in HIV-positive persons. Effectiveness of vitamin D supplementation on inflammation and patient outcomes should be investigated.
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Affiliation(s)
- Leah Shepherd
- Department of Infection and Population Health, University College London Medical School, London, United Kingdom
| | | | - Jean-Philippe Bastard
- Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Soraya Fellahi
- Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Jaqueline Capeau
- Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Joanne Reekie
- Department of Infection and Population Health, University College London Medical School, London, United Kingdom The Kirby Institute University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Reiss
- Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Anders Blaxhult
- Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | | | - Clifford Leen
- Edinburgh Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom Edinburgh Infectious Diseases Edinburgh University, Edinburgh, United Kingdom
| | - Ole Kirk
- Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Centre for Viral Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jens D Lundgren
- Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Centre for Viral Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Mocroft
- Department of Infection and Population Health, University College London Medical School, London, United Kingdom
| | - Jean-Paul Viard
- Centre de Diagnostic et de Thérapeutique Hôtel-Dieu, APHP, and EA 3620, Université Paris Descartes, Paris, France
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Wohl DA, Orkin C, Doroana M, Pilotto JH, Sungkanuparph S, Yeni P, Vanveggel S, Deckx H, Boven K. Change in vitamin D levels and risk of severe vitamin D deficiency over 48 weeks among HIV-1-infected, treatment-naive adults receiving rilpivirine or efavirenz in a Phase III trial (ECHO). Antivir Ther 2014; 19:191-200. [PMID: 24430534 DOI: 10.3851/imp2721] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This analysis assessed changes in serum 25-hydroxyvitamin D (25[OH]D; the precursor form of active vitamin D) in antiretroviral-naive adults receiving rilpivirine or efavirenz over 48 weeks in a randomized, double-blind, Phase III trial (ECHO). METHODS ECHO included 690 patients randomized 1:1 to receive rilpivirine 25 mg once daily (n=346) or efavirenz 600 mg once daily (n=344), plus tenofovir disoproxil fumarate/emtricitabine. 25(OH)D was measured in stored serum samples collected at baseline, and weeks 24 and 48. Proportions of patients with optimal/sufficient (≥30 ng/ml), insufficient (21-29 ng/ml), deficient (10-20 ng/ml) and severely deficient (<10 ng/ml) 25(OH)D levels were determined. Data are presented for patients with paired baseline and week 48 25(OH)D data (rilpivirine, n=292; efavirenz, n=290). RESULTS After 48 weeks, mean 25(OH)D levels remained largely unchanged from baseline with rilpivirine (-0.2 ng/ml; P=0.57 versus no change), but were significantly reduced with efavirenz (-2.5 ng/ml; P<0.0001 versus no change). When adjusting for season of randomization and the combined variable of race (Black/African American, White/Caucasian, Asian, other race) and ethnicity (Hispanic or Latino and not Hispanic or not Latino), the conclusion about the treatment difference between the rilpivirine and efavirenz treatment groups remained valid. At baseline the proportion of patients with severe 25(OH)D deficiency was similar in both groups (5%) but was significantly lower with rilpivirine than efavirenz at week 48 (5% versus 9%, respectively; P=0.032). Furthermore, of the patients with 25(OH)D insufficiency/deficiency at baseline, the proportion who developed severe 25(OH)D deficiency at week 48 was significantly lower with rilpivirine than efavirenz (2% versus 8%, respectively; P=0.0079). CONCLUSIONS Rilpivirine had little effect on 25(OH)D, whereas efavirenz resulted in a significant reduction in 25(OH)D levels and an increase in the risk of severe 25(OH)D deficiency.
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Affiliation(s)
- David A Wohl
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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13
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Marcondes NA, Raimundo FV, Vanacor R, Corte BP, Ascoli AM, de Azambuja AZ, Scopel L, Dos Santos PV, Dalcin PDTR, Rotta LN, Furlanetto TW, Faulhaber GAM. Hypovitaminosis D in patients with cystic fibrosis: a cross-section study in South Brazil. CLINICAL RESPIRATORY JOURNAL 2014; 8:455-9. [PMID: 24345187 DOI: 10.1111/crj.12097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 10/31/2013] [Accepted: 12/13/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) patients have a susceptibility to vitamin D deficiency because of nutrient malabsorption. OBJECTIVES To evaluate the prevalence of hypovitaminosis D in CF patients and the factors associated with serum 25-hydroxyvitamin D levels. METHODS We evaluated the prevalence of vitamin D deficiency defined as 25-hydroxyvitamin D <30 ng/mL, as suggested recently by the Cystic Fibrosis Foundation, and factors associated with its serum levels. Patients with confirmed CF were included. Nutritional status and hospital admissions were evaluated. Serum C-reactive protein, calcium, phosphate, magnesium, albumin, 25-hydroxyvitamin D and parathyroid hormone levels were measured. Lung function was evaluated by spirometry, and clinical and chest radiographic scores were assessed. Statistical significance level was set at P < 0.05. RESULTS Fifty-nine patients were included. Prevalence of hypovitaminosis D was 61%. Patients with pancreatic insufficiency had a trend to have higher vitamin D levels. Sixteen patients had severe lung disease with percentage of forced expiratory volume in 1 s predicted below 40%. After multivariate analysis, body mass index and hospitalization in the last month remained significantly associated with serum vitamin D levels. CONCLUSIONS Vitamin D insufficiency is still a problem in CF patients, even in those receiving supplementation.
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Affiliation(s)
- Natália Aydos Marcondes
- Programa de Pós Graduação em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
The positive effects of vitamin D in different acute and chronic diseases (e.g., bone and renal disorders, acute and chronic respiratory tract infections, and diabetes mellitus), and regulation of immune system function have been shown. In this review vitamin D status and the effects of its supplementation alone or in combination with other bone-modifying substances like calcium and bisphosphonates on the different aspects of human health have been investigated in HIV+ individuals. Three scientific electronic databases have been investigated for extracting related articles. Searching only PubMed yielded 59 results with ‘HIV OR AIDS’ and ‘Vitamin D’ keywords. Because many of the studies in this field are observational or cross-sectional, designing comprehensive and eligible randomized clinical trials has been recommended by several authors in order to develop evidence-based clinical practice guidelines to determine the best regimen of vitamin D supplementation in HIV-infected patients.
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Affiliation(s)
- Ali Tafazoli
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, 1417614411, PO Box 14155/6451, Iran
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Theodorou M, Sersté T, Van Gossum M, Dewit S. Factors associated with vitamin D deficiency in a population of 2044 HIV-infected patients. Clin Nutr 2013; 33:274-9. [PMID: 23680190 DOI: 10.1016/j.clnu.2013.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS The high prevalence of vitamin D deficiency in HIV-infected patients has been demonstrated but there are still controversies regarding to the role of antiretroviral therapy (ART) in this setting. The aims of this study was to validate factors associated with vitamin D deficiency in a large cohort of HIV-infected patients. METHODS A retrospective analysis of 2044 consecutive patients from December 2005 to March 2011 was conducted. Factors independently associated with vitamin D deficiency (<30 ng/ml and <10 ng/ml) were analyzed. Vitamin D levels were compared according to CD4 count, viral load and ART modalities. RESULTS vitamin D was <30 ng/ml in 89.2% and <10 ng/ml in 32.4%. The median value was 13.8 ng/ml (4-102). Winter season, female sex, heterosexual acquisition of HIV, the need of second lines (complex and sequential treatment modalities) and a longer duration of ART were independently associated with vitamin D deficiency (<30 ng/ml). CD4 count <200/μl, advanced stages of disease and the current efavirenz use were independently associated with severe vitamin D deficiency (<10 ng/ml). Median vitamin D levels was 14.1 ng/dl when CD4 ≥200/μl, 11.5 ng/dl when CD4<200 (p = 0.0003). The ART modalities had a significant influence on vitamin D concentrations, the highest vitamin D level was observed in the absence of treatment. CONCLUSIONS In HIV-infected patients, vitamin D deficiency is associated with ART modalities and duration. The most severe vitamin D deficiencies are associated with low CD4 count, the use of efavirenz and advanced stages of disease severity.
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Affiliation(s)
- Maria Theodorou
- Internal Medicine, CHU Saint Pierre, Université libre de Bruxelles, Bruxelles, Belgium
| | - Thomas Sersté
- Hepato-Gastroenterology and Clinical nutrition, CHU Saint Pierre, Université libre de Bruxelles, Bruxelles, Belgium.
| | - Marc Van Gossum
- Hepato-Gastroenterology and Clinical nutrition, CHU Saint Pierre, Université libre de Bruxelles, Bruxelles, Belgium
| | - Stéphane Dewit
- Infectious Diseases, CHU Saint Pierre, Université libre de Bruxelles, Bruxelles, Belgium
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Botros D, Somarriba G, Neri D, Miller TL. Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:351-63. [PMID: 22933247 DOI: 10.1007/s11904-012-0135-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
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Affiliation(s)
- Diana Botros
- Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami, Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101, USA.
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Poudel-Tandukar K, Poudel KC, Jimba M, Kobayashi J, Johnson CA, Palmer PH. Serum 25-hydroxyvitamin d levels and C-reactive protein in persons with human immunodeficiency virus infection. AIDS Res Hum Retroviruses 2013; 29:528-34. [PMID: 23003113 DOI: 10.1089/aid.2012.0120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection has frequently been associated with vitamin D deficiency as well as chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D [25(OH)D] and high-sensitivity C-reactive protein (CRP) in a cohort of HIV-positive people. A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 16 to 60 years residing in the Kathmandu Valley, Nepal. Serum high-sensitivity CRP concentrations and serum 25(OH)D levels were measured by the latex agglutination nephelometry method and the competitive protein-binding assay, respectively. The relationship between serum CRP concentrations and 25(OH)D serum level was assessed using multiple logistic regression analysis with adjustment of potential cardiovascular and HIV-related factors. The proportions of participants with 25(OH)D serum levels <20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were 83.2%, 15.5%, and 1.3%, respectively. The mean 25(OH)D serum levels in men and women were 15.3 ng/ml and 14.4 ng/ml, respectively. Participants with a 25(OH)D serum level of <20 ng/ml had a 3.2-fold higher odds of high CRP (>3 mg/liter) compared to those with a 25(OH)D serum level of ≥20 ng/ml (p=0.005). Men and women with a 25(OH)D serum level of <20 ng/ml had 3.2- and 2.7-fold higher odds of high CRP (>3 mg/liter), respectively, compared to those with a 25(OH)D serum level of ≥20 ng/ml. The relationships remained significant only in men (p =0.02) but not in women (p=0.28). The risk of having a high level of inflammation (CRP>3 mg/liter) may be high among HIV-positive men and women with a 25(OH)D serum level of <20 ng/ml.
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Affiliation(s)
| | - Krishna C. Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
- School of Community and Global Health, Claremont Graduate University, Claremont, California
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Kobayashi
- Department of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan
| | - C. Anderson Johnson
- School of Community and Global Health, Claremont Graduate University, Claremont, California
| | - Paula H. Palmer
- School of Community and Global Health, Claremont Graduate University, Claremont, California
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Griffin AT, Arnold FW. Review of metabolic, immunologic, and virologic consequences of suboptimal vitamin D levels in HIV infection. AIDS Patient Care STDS 2012; 26:516-25. [PMID: 22861070 DOI: 10.1089/apc.2012.0145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low 25-hydroxyvitamin D levels are common in the general and HIV-infected populations alike. Defined as levels less than 30 ng/mL, suboptimal vitamin D is known to afflict over 70% of representative samples from each group in resource-rich countries with even greater prevalence in resource-poor regions of the world. In both those with and without HIV, dark skin, low vitamin D intake, exiguous exposure to sunlight, and season act as risk factors for suboptimal vitamin D levels. In those infected with HIV, antiretroviral therapy, particularly non-nucleoside reverse transcriptase inhibitors (NNRTIs), increase risk for low vitamin D as well. Furthermore, metabolic aberrations, including obesity and hyperlipidemia, and miscellaneous risk factors, such as advanced AIDS and substance abuse, have been linked to suboptimal vitamin D in those with HIV. While the skeletal and cardiovascular systems of HIV patients may be adversely impacted as a result of low levels, recent data have also linked low vitamin D to decreased CD4 counts, higher viral loads, and to critical end points including progression to AIDS events and death. More research is needed to confirm these potential consequences of low vitamin D in those with HIV and to discern the benefits of routine screening for and treatment of low vitamin D in this population.
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Affiliation(s)
- Allen T. Griffin
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Forest W. Arnold
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
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