title: Liver-related factors associated with low vitamin D levels in HIV and HIV/HCV coinfected patients and comparison to general population.
abstract: OBJECTIVE
  Low 25-Hydroxyvitamin D (25[OH]D) was associated with severe fibrosis and low sustained virological response (SVR) after interferon (IFN)-based therapy in chronic hepatitis C. Furthermore, hypovitaminosis D was reported in HIV-infected individuals, but its role in liver disease progression in HIV/HCV coinfection is unknown.
  
  
  METHODS
  25(OH)D was retrospectively measured in 237 HIV-infected patients (93 with HCV coinfection) and 76 healthy controls. Multivariate analysis included season, immuno-virological data, combined antiretroviral therapy (cART) and, in a subgroup of 51 HIV/HCV-genotype 1 coinfected patients, factors influencing SVR to pegylated-IFN and ribavirin. In a group of 20 patients, liver expression of cytochrome (CY)-P27A1 and CYP2R1, 25-hydroxylating enzymes, was assessed by immunohistochemistry.
  
  
  RESULTS
  Median 25(OH)D levels were 23.4 (interquartile range 16.7-33.7) ng/mL in the HIV-infected population and 24 ng/mL (18.3-29.5) in healthy controls (p=0.9). At multiple regression analysis, only winter/spring measurements correlated with lower 25(OH)D levels. No correlation with HCV coinfection, nor with cART regimens was found. Low 25(OH)D was independently associated with advanced fibrosis in HIV/HCV coinfected patients (p=0.023), whereas no association emerged with SVR to IFN-based therapy. CYP27A1 and CYP2R1 expression was associated neither with 25(OH)D serum levels nor with HCV-infection, liver histology, or cART.
  
  
  CONCLUSIONS
  In our experience, despite the high prevalence of 25(OH)D insufficiency, HIV and HCV-infection did not seem to influence vitamin D status. The role of HIV, HCV and cART on hypovitaminosis D needs further validation in larger cohorts that account for the vitamin levels in general populations and for seasonal and regional variability.
authors.affiliation: Section of Infectious Diseases and Immunopathology, Department of Clinical Sciences L. Sacco, Università degli Studi di Milano, L. Sacco Hospital, Milan, Italy. laura.milazzo@unimi.it
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.forename: Cristina
authors.initials: C
authors.lastname: Mazzali
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bestetti
authors.forename: Erika
authors.initials: E
authors.lastname: Longhi
authors.forename: Antonella
authors.initials: A
authors.lastname: Foschi
authors.forename: Anita
authors.initials: A
authors.lastname: Viola
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Vago
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.forename: Carlo
authors.initials: C
authors.lastname: Parravicini
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007372:Interferons / Q000008:administration & dosage; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications* / Q000503:physiopathology
chemical_list: D000998:Antiviral Agents; D014807:Vitamin D; D012254:Ribavirin; D007372:Interferons