title: Vitamin D deficiency and its association with low bone mineral density, HIV-related factors, hospitalization, and death in a predominantly black HIV-infected cohort.
abstract: BACKGROUND
  Low bone mineral density (BMD) is common among patients infected with human immunodeficiency virus (HIV) and present in higher rates in black subjects. This study assessed vitamin D levels in HIV cases versus noninfected matched controls to determine if deficiency was associated with BMD and HIV clinical outcomes.
  
  
  METHODS
  In total, 271 military beneficiaries with HIV underwent dual energy x-ray absorptiometry (DEXA) screening in 2001-2. Serum 25OH-vitamin D levels were determined using stored serum from the time of DEXA and 6-18 months prior. Two non-HIV-infected controls for each active duty case (n = 205) were matched on age, sex, race, zip code, and season using the Department of Defense Serum Repository (DoDSR). Vitamin D levels <20 ng/mL were considered deficient. HIV-related factors and clinical outcomes were assessed using data collected in the DoD HIV Natural History study.
  
  
  RESULTS
  In total, 165 of 205 (80.5%) active duty HIV cases had 2 matched controls available. HIV cases had greater odds of for vitamin D deficiency (VDD) compared with controls (demographics adjusted paired data odds ratio [OR], 1.46, 95% confidence interval [CI], .87-2.45), but this was not statistically significant. Blacks were disproportionately deficient (P <.001) but not relative to HIV status or BMD. Low BMD was associated with typical risk factors (low body mass index and exercise levels, alcohol use); given limited available data the relationship between tenofovir exposure and VDD or low BMD could not be determined. Analysis of HIV-specific factors and outcomes such as exposure to antiretrovirals, HIV progression, hospitalizations, and death revealed no significant associations with vitamin D levels.
  
  
  CONCLUSIONS
  VDD was highly prevalent in black HIV- infected persons but did not explain the observed racial disparity in BMD. Vitamin D deficiency was not more common among HIV- infected persons, nor did it seem associated with HIV- related factors/clinical outcomes.
authors.affiliation: Department of Medicine, William Beaumont Army Medical Center, El Paso, Texas, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Sherwood
authors.forename: Octavio C
authors.initials: OC
authors.lastname: Mesner
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Hadigan
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Wilkins
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Aronson
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001741:Black or African American; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000378:metabolism* / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012307:Risk Factors; D014481:United States; D014808:Vitamin D Deficiency / Q000208:ethnology / Q000378:metabolism / Q000473:pathology* / Q000821:virology*