title: Prevalence of vitamin D deficiency and its related risk factor in a Spanish cohort of adult HIV-infected patients: effects of antiretroviral therapy.
abstract: We analyzed serum 25(OH) cholecalciferol [25(OH)D] levels and factors related to deficiency (<20 ng/ml) or insufficiency (<30 ng/ml) in a cohort of Spanish HIV-infected patients and compared them with an age- and latitude-matched population from another study. We prospectively assessed 25(OH)D deficiency/insufficiency in a cohort of 352 HIV patients during 2009-2010. Predisposing factors were recorded and their relationship to low levels was assessed by logistic regression; a nutritional survey examined intake, nutritional status, and sunlight exposure in a subgroup of 92 patients. We studied the correlation of 25(OH)D with parathyroid hormone (PTH) and alkaline phosphatase. Age-, sex-, and race/ethnicity-adjusted vitamin D deficiency (<20 ng/ml) was 44.0% (95% CI, 38.8-49.4%) and insufficiency (<30 ng/ml) was 71.6% (95% CI, 66.9-76.3). Deficiency was 16.4% more prevalent in our sample than in non-HIV-infected Spaniards. Lower sunlight exposure was the only factor related to lower levels in the lifestyle and nutritional survey (p=0.045). In multiple logistic regression, higher body mass index (BMI), black race/ethnicity, lower seasonal sunlight exposure, men who have sex with men (MSM), and heterosexual transmission categories, efavirenz exposure and lack of HIV viral suppression were independently associated with deficiency/insufficiency. These variables predicted 79% of cases [AUC=0.872 (95% CI, 0.83-0.91)]. Patients receiving protease inhibitors (PIs) [OR 4.0 (95% CI, 1.3-12.3); p=0.014] or NNRTI [OR 3.6 (95% CI, 1.7-11.2); p=0.025] had higher odds of increased PTH levels; this was significant only in 25(OH)D-deficient patients (p=0.004). As in less insolated areas, the prevalence of vitamin D deficiency/insufficiency was high in HIV-infected patients in Spain; among treated patients, levels were higher with PIs than with efavirenz.
authors.affiliation: Internal Medicine Service, H. Severo Ochoa, Madrid, Spain. mcerveroj@gmail.com
authors.forename: Miguel
authors.initials: M
authors.lastname: Cervero
authors.forename: José Luis
authors.initials: JL
authors.lastname: Agud
authors.forename: Concepción
authors.initials: C
authors.lastname: García-Lacalle
authors.forename: Victoria
authors.initials: V
authors.lastname: Alcázar
authors.forename: Rafael
authors.initials: R
authors.lastname: Torres
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Jusdado
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno Guillén
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013472:Sunlight; D011795:Surveys and Questionnaires; D014808:Vitamin D Deficiency / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology