Tenofovir-linked hyperparathyroidism is independently associated with the presence of vitamin D deficiency.
BACKGROUND
To determine patient and treatment characteristics associated with vitamin D deficiency (VDD) in an UK inner city HIV-1-positive adult cohort.


METHODS
Two hundred twenty-seven HIV-positive patients attending prospectively for routine blood tests in winter had serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations and other routine chemistry measured. Those with and without VDD were defined as having serum 25-hydroxyvitamin D concentrations <50 nmol/L and >75 nmol/L, respectively. Characteristics were compared between patients with and without VDD. The effects of VDD, tenofovir use, and their interaction on chemical measures were investigated.


RESULTS
VDD was found in 57% (131 of 227) of patients. Independent associations included nonwhite ethnicity [adjusted odds ratio (95% confidence interval): 7.40 (2.52 to 21.7)], higher random blood glucose [2.38 (1.24 to 4.57) per mmol/L], higher estimated glomerular filtration rate [eGFR: 1.04 (1.01 to 1.06)], and higher PTH [1.19 (1.00 to 1.42)]. PTH was higher in those receiving tenofovir (median 7.2 pmol/L) than other patients (4.3; P < 0.001) overall, but high PTH with tenofovir occurred only in the context of VDD. Tenofovir use was not associated with serum creatinine or eGFR overall but interacted with vitamin D status (P = 0.05 and P = 0.08, respectively), being linked to somewhat higher creatinine and lower eGFR among patients without VDD but higher eGFR in VDD patients.


CONCLUSIONS
25(OH) VDD is associated with tenofovir-linked hyperparathyroidism and also with higher eGFR.
Rosenvinge
Melanie M
MM
Department of Genitourinary Medicine, St. George's Healthcare NHS Trust, London, UK.
Gedela
Keertie
K
Copas
Andrew J
AJ
Wilkinson
Anne
A
Sheehy
Catriona A
CA
Bano
Gul
G
Hay
Phillip E
PE
Pakianathan
Mark R
MR
Sadiq
S Tariq
ST
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D006961:Hyperparathyroidism / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D000068698:Tenofovir; D006113:United Kingdom; D014505:Urban Population; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
D063065:Organophosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D; D000068698:Tenofovir; C104450:25-hydroxyvitamin D; D000225:Adenine