Association between initiation of antiretroviral therapy with efavirenz and decreases in 25-hydroxyvitamin D.
BACKGROUND
We aimed to determine whether antiretroviral therapy (ART) initiation with efavirenz (EFV) is associated with decreases in 25-hydroxyvitamin D (25[OH]D) compared with non-EFV regimens.


METHODS
25(OH)D was measured from stored plasma samples in 87 ART-naive HIV-positive patients prior to ART initiation with EFV-containing (n=51) or non-EFV-containing (89% with protease inhibitors; n=36) regimens from a single clinic in Cleveland (OH, USA). A repeat measurement was made 6-12 months after ART initiation. The change in 25(OH)D after ART initiation and the prevalence of patients with hypovitaminosis D (< or = 37.5 nmol/l [15 ng/ml]) after ART initiation was compared in those who initiated ART with and without EFV using multivariable linear and modified Poisson regression, respectively.


RESULTS
Prior to ART initiation, the median (interquartile range [IQR]) 25(OH)D concentration was 52.7 nmol/l (IQR 32.2-72.1), with 33% prevalence of hypovitaminosis D. After 6-12 months of ART, 25(OH)D decreased by a mean +/-se of -12.7 +/-3.7 nmol/l in the EFV group relative to the non-EFV group (P=0.001) after adjustment for baseline 25(OH)D concentration, race and season (non-summer versus summer) at the visit 6-12 months after ART initiation. Similarly, after multivariable adjustment, the risk of hypovitaminosis D after ART initiation was significantly higher in the EFV group compared with the non-EFV group (prevalence ratio 1.8 [95% confidence interval 1.2-2.8]; P=0.007).


CONCLUSIONS
ART initiation with EFV is associated with significant decreases in 25(OH)D and an increased risk of hypovitaminosis D compared with non-EFV regimens.
Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, MD, USA. tbrown27@jhmi.edu
Todd T
TT
Brown
Grace A
GA
McComsey
D000293:Adolescent; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects*; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D015497:HIV-1; D006801:Humans; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000139:chemically induced*; D055815:Young Adult
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D014807:Vitamin D; C104450:25-hydroxyvitamin D; C098320:efavirenz