Hypovitaminosis D and bone mineral density in human immunodeficiency virus-infected men from India, with or without antiretroviral therapy.
OBJECTIVE
To study the vitamin D status and bone mineral density (BMD) in men infected with human immunodeficiency virus (HIV) in a tertiary care center from southern India.


METHODS
We conducted a cross-sectional study of 35 HIV-infected men (between 20 and 50 years old) receiving highly active antiretroviral therapy (HAART) (group 1) in comparison with 35 age- and body mass index-matched HIV-positive antiretroviral therapy-naïve men (group 2) and 35 HIV-negative healthy control subjects (group 3).


RESULTS
A significantly greater proportion (P = .002) of patients (74%) in the HAART group had vitamin D deficiency (<20 ng/mL) in comparison with the other 2 groups (37% in each group). The mean intact parathyroid hormone level was higher (P<.001) and the mean duration of exposure to sunlight was lower (P = .001) in the HAART group than in the other 2 groups. By logistic regression analysis, HAART was found to be significantly associated with vitamin D deficiency. The BMD in the femoral neck was significantly lower in men with HIV infection who were receiving HAART in comparison with the other 2 groups (P = .006). On multivariate logistic regression, older age, low body mass index, and high parathyroid hormone levels emerged as factors significantly associated with decreased BMD at the femoral neck.


CONCLUSIONS
A significant proportion of patients receiving HAART had vitamin D deficiency. The secondary hyperparathyroidism probably due to vitamin D deficiency is an important contributing factor for the observed changes in BMD. Vitamin D deficiency noted in this group is probably multifactorial, and further research is needed to determine whether the effect of HAART on vitamin D metabolism is an additional causative factor and what benefit vitamin D supplementation might confer in these patients.
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India. thomasvpaul@yahoo.com
Thomas Vizhalil
TV
Paul
Hesarghatta Shyamasunder
HS
Asha
Nihal
N
Thomas
Mandalam Subramanian
MS
Seshadri
Priscilla
P
Rupali
Ooriapadickal Cherian
OC
Abraham
Susanne Alexander
SA
Pulimood
Arun
A
Jose
D000328:Adult; D000375:Aging; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects; D003430:Cross-Sectional Studies; D004032:Diet; D005272:Femur Neck; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D013472:Sunlight; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D055815:Young Adult
D010281:Parathyroid Hormone