Vitamin D status in an urban Spanish HIV‐infected patient cohort and its relationship with most frequent antiretroviral therapy regimens
Authors: Cervero M , Agud J , Torres R , Jusdado J 
Published: November 2012

Purpose

We assessed vitamin D status in HIV‐infected patients and its relation to classic, related‐HIV risk factors and therapeutic regimens.

Methods

Out of 450 HIV‐infected patients followed in the H. Severo Ochoa (Madrid, Spain), we selected 352 patients in which vitamin D levels had been assessed (2009 to 2010). We describe demographics, cART duration, cART, viral load (VL), CD4+ cell count, 25(OH)D levels, iPTH, MDRD, serum albumin and calcium. Vitamin D status cutoff points were: 1. deficiency (vitDd): 25(OH)D levels <20 ng/mL; 2. insuficiency (vitDi): 20 to 29.99 ng/mL and 3. optimal (vitDo): 25(OH)D ≥ 30 ng/mL.

Results

Median CD4+ cell count was 501 cells/µL; median VL 40 copies/mL. 277 patients (78.7%) had less than 50 copies/mL. 310 patients (88.1%) were on cART. The proportions of patients with vitDd, vitDi and vitDo were 155/352 (44%), 97 (27.6%) and 100 (28.5%). Black patients had 14.2% of vitDd (22 patients out of 155 patients with vitDd), 7.2% (7/97) vitDi and 1% (1/100) vitDo (p=.001) vs. global sample; therefore, 29 out of 30 (96.7%) black patients had vitDd/vitDi, vs. 71.6% in global sample. Former IDUs had more vidDo (p<0.001 vs. other risk groups). Among patients with less than 50 copies/mL, the proportions of vitDd, vitDi and vitDo were 77.4%, 68% and 91% respectively, (p=.0001). Of the cART, only PI monotherapy was associated with significant differences in vitD (see Table).

vitDd n=155 (44%)
vitDi n=97 (27.6%)
vitDo n=100 (28.4%)
p

Age
28 (23–34)
28 (25–35)
27 (23–35)
0.77

Gender n (%) Female/male
59 (38.1%) 96 (61.6%)
23 (23.7%) 74 (76.39%)
34 (34%) 66 (66%)
0.06

Ethnic background n (%) Caucasian/Black/Hispanic
125 (80.6%) 22 (14.2%) 8 (5.2%)
83 (85.6%) 7 (7.2%) 7 (7.2%)
91 (91%) 1 (1%) 8 (8%)
0.07 0.001* 0.64

Risk factor HTX/MSM/IDU/other
76 (49.1%) 18 (11.6%) 59 (38.1%) 2 (1.3%)
34 (35.1%) 27 (27.8%) 33 (34%) 3 (3.1%)
27 (27%) 9 (9%) 63 (63%) 1 (1%)
0.001* 0.0001* 0.0001* 0.45

Calcium (mg/dL)
9.3 (9–9.6)
9.2 (8.5–9.5)
9.2 (8.9–9.5)
0.08

Albumin (g/dL)
4.4 (4.2–4.6)
4.4 (4.1–4.6)
4.4 (4.2–4.6)
0.59

iPTH (pg/mL)
48.2 (34.2–67.8)
46 (32.8–59.45)
45.2 (34.57–59.9)
0.51

Phosphorus (mg/dL)
3.29 (3.1–3.6)
3.296 (2.9–3.3)
3.296 (3–3.296)
0.053

Glomerular filtration rate (MDRD)
88.2 (77.3–102)
85.9 (74.7–95.5)
84 (73.9–92.3)
0.03

GFR <60 n (%)
6 (3.9%)
1 (1%)
9 (9%)
0.02

Blood glucose (mg/dL)
96 (88–104)
96 (89–104)
97 (89–104)
0.99

HCV (%)
92 (59.4%)
58 (59.8%)
33 (33%)
0.0001*

HBV (%)
3 (1.9%)
6 (6.2%)
4 (4%)
0.22

CD4+
519 (334–700)
449 (307–637)
505 (360–660)
0.36

HIV copies/mL (%)>50<50
35 (22.6%) 120 (77.4%)
31 (32.4%) 66 (68%)
9 (9%) 91 (91%)
0.0001*

HAART, n (%)
73 (47.1%)
45 (46.4%)
67 (67%)
0.003*

Season, n (%) spring/summer/ autumn/winter
52 (33.5%) 20 (12.9%) 35 (22.6%) 48 (31%)
15 (15%) 25 (25.8%) 38 (39.2%) 19 (19.6%)
1 (1%) 37 (37%) 58 (58%) 4 (4%)
0.0001* 0.0001* 0.0001* 0.0001*

HAART regimens (patients with <50 copies)
vitDd n= 118
VitDi n=64
VitDo n=91

Duration (months)
85 (40–143)
64 (28–138)
86 (43–140)
0.344

NNRTI+TDF
36 (30.51%)
23 (35.94%)
21 (23.07%)
0.258

NNRTI+no_TDF
16 (13.56%)
8 (12.5%)
9 (9.89%)
0.745

PI+TDF
28 (23.73%)
15 (23.44%)
25 (27.47%)
0.728

PI+no−TDF
14 (11.28%)
9 (14.06%)
15 (16.48%)
0.602

NNRTI+PI+TDF
1 (0.85%)
0 (0%)
0 (0%)
0.519

NNRTI+PI+no−TDF
3 (3%)
1 (1.56%)
3 (3.29%)
0.781

Other+TDF
2 (2.54%)
1 (1.56%)
0 (0%)
0.475

Other+no TDF
9 (7.63%)
5 (7.81%)
5 (5.49%)
0.821

PI monotherapy
9 (7.63%)
2 (3.12%)
13 (14.28%)
0.039*

On multivariate analysis following variables were related to increased risk of vitD insuficiency/deficiency, black vs. white race (OR 10.6 [95% CI 1.2–94], p=.033); heterosexual/MSM risk vsm IDU risk groups (OR 2.37 [95% CI 1.13–4.93], p=.022) and (OR 3.25 [95% CI 1.25–8.50], p=.016) and VL>50 copies/mL (OR 2.56 [95% CI 1.10–7.25], p=.040). Less risk of vitamin D insufficiency/deficiency was found in patients on PI monotherapy vs. no treatment (OR 0.08 [95% CI 0.01–0.6], p=.018); Hispanic (South American) patients vs. white (OR 0.18 [95% CI 0.05–0.68], p=.012) and summer/autumn vs. spring samples (OR 0.015 [95% CI 0.002–0.116], p=.0001 summer) and (OR 0.013 [95% CI 0.02–0.099), p=.0001, for autumn).

Conclusions

1: Vitamin D status was associated with ethnic background, season and non‐suppressed VL. 2: Former IDUs had less vitamin D deficiency/insufficiency, perhaps due to more outdoor jobs. 3: As in the MONET study, PI monotherapy had a positive impact on vitD.