Higher vitamin D levels in HIV‐infected out‐patients on treatment with boosted protease inhibitor monotherapy

• Published in: HIV medicine Vol. 14; no. 9; pp. 556 - 562
• Main Authors: Cervero, M, Agud, JL, Torres, R, García‐Lacalle, C, Alcázar, V, Jusdado, JJ, Moreno, S
• Format: Journal Article
• Language: English
• Published: England 01.10.2013
• Subjects: Adult; African Continental Ancestry Group; Albumin; antiretroviral therapy; Antiretroviral Therapy, Highly Active - adverse effects; combination antiretroviral therapy; Cross-Sectional Studies; deficiency; Female; Heliotherapy; highly active antiretroviral therapy; HIV; HIV Infections - blood; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Human immunodeficiency virus 1; Humans; Male; Outpatients; regimen; Spain - epidemiology; Viral Load; vitamin D; Vitamin D - blood; Vitamin D - therapeutic use; Vitamin D Deficiency - drug therapy; Vitamin D Deficiency - epidemiology; Vitamin D Deficiency - etiology; Young Adult; Spain; HIV; deficiency; antiretroviral therapy; vitamin D; highly active antiretroviral therapy; combination antiretroviral therapy; regimen
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12049

Objectives We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy (cART), including boosted protease inhibitor (PI) monotherapy. Methods For this cross‐sectional study, out of 450 HIV‐infected patients followed in the Hospital Severo Ochoa (Madrid, Spain), we selected 352 patients for whom vitamin D levels had been measured (January 2009 to December 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load (VL), CD4 cell count, and concentrations of 25(OH)‐vitamin D [25(OH)‐D], parathyroid hormone (PTH), albumin and calcium. Vitamin D status cut‐off points were: (1) deficiency (vitDd): 25(OH)‐D < 20 ng/mL; (2) insufficiency (vitDi): 25(OH)‐D from 20 to 29.99 ng/mL; and (3) optimal (vitDo): 25(OH)‐D ≥ 30 ng/mL. Results The percentages of patients with vitDd, vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty‐nine out of 30 (96.7%) Black patients had vitDd or vitDi, vs. 71.6% in the global sample (P < 0.001). Former injecting drug users (IDUs) had a higher prevalence of vitDo (P < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV‐1 RNA copies/mL were 77.4, 68 and 91%, respectively (P < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels (P = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs. Caucasian ethnicity [odds ratio (OR) 10.6; 95% confidence interval (CI) 1.2–94; P = 0.033]; heterosexual (OR 2.37; 95% CI 1.13–4.93; P = 0.022) or men who have sex with men (MSM) (OR 3.25; 95% CI 1.25–8.50; P = 0.016) transmission category vs. former IDU; and VL > 50 copies/mL (OR 2.56; 95% CI 1.10–7.25; P = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment (OR 0.08; 95% CI 0.01–0.6; P = 0.018). Conclusions Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.