Hyperparathyroidism and complications associated with vitamin D deficiency in HIV-infected adults in New York City, New York.
Although recent studies report a high prevalence of vitamin D deficiency in HIV-infected adults similar to that in the general population, metabolic complications of vitamin D deficiency may be worsened with HIV infection and remain insufficiently characterized. We conducted a retrospective cross-sectional cohort study to determine prevalence and correlates of vitamin D deficiency and hyperparathyroidism among HIV-infected patients attending an urban clinic. Vitamin D deficiency was defined as 25(OH)-vitamin D <20 ng/ml and insufficiency as 20 to <30 ng/ml, and hyperparathyroidism as parathyroid-hormone >65 pg/ml. We used the X(2) test to compare proportions and logistic regression to assess for associations. Among 463 HIV-infected patients, the prevalence of vitamin D deficiency was 59%. The prevalence of hyperparathyroidism was 30% among patients with vitamin D deficiency, 23% among those with insufficiency, and 12% among those with sufficient vitamin D levels. Vitamin D deficiency was associated with increased odds of hyperparathyroidism. Severe vitamin D deficiency was associated with elevated alkaline phosphatase, a marker for increased bone turnover. Although efavirenz use was associated with vitamin D deficiency, and protease inhibitor use with decreased odds of vitamin D deficiency, there was no statistical difference in rates of hyperparathyroidism stratified by combination antiretroviral therapy (cART) use. Given the increased risk of osteopenia with HIV infection and cART use, vitamin D supplementation for all HIV-infected patients on cART should be prescribed in accordance with the 2011 Endocrine Society guidelines. In HIV-infected patients with severe vitamin D deficiency or hyperparathyroidism, screening for osteomalacia and osteopenia may be warranted.
Bellevue Hospital Center, New York City Health and Hospital Corporation, New York, USA. ckwan@cdc.gov
Candice K
CK
Kwan
Benjamin
B
Eckhardt
Jonathan
J
Baghdadi
Judith A
JA
Aberg
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D001851:Bone Diseases, Metabolic / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010018:Osteomalacia / Q000453:epidemiology; D011236:Prediabetic State / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*
D014807:Vitamin D