title: Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic.
abstract: Hypovitaminosis D is a very common disorder, regarding both Western and developing countries. A growing amount of data over the last years have shown vitamin D deficiency to be high prevalent among HIV-positive subjects. In addition to "classic" risk factors, such as female sex, low dietary intake, dark skin pigmentation and low sun exposure, HIV-related factors, including immune activation and antiretroviral adverse effects, may affect vitamin D status. Even if both protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been associated with low vitamin D levels, available evidences have failed to univocally associate hypovitaminosis D with specific antiretroviral class effects. Low vitamin D is known to have a negative impact not only on bone health, but also on neurocognitive, metabolic, cardiovascular and immune functions. Similarly to the general population, several studies conducted on HIV-infected subjects have associated hypovitaminosis D with a greater risk of developing osteopenia/osteoporosis and fragility fractures. Analogously, vitamin D deficiency has been described as an independent risk factor for cardiovascular disease and metabolic disorders, such as insulin resistance and type 2 diabetes mellitus. Last EACS guidelines suggest to screen for hypovitaminosis D every HIV-positive subject having a history of bone disease, chronic kidney disease or other known risk factors for vitamin D deficiency. Vitamin D repletion is recommended when 25-hydroxyvitamin D levels are below 10 ng/ml. Furthermore, it may be indicated in presence of 25OHD values between 10 and 30 ng/ml, if associated with osteoporosis, osteomalacia or increased parathyroid hormone levels. The optimal repletion and maintenance dosing regimens remain to be established, as well as the impact of vitamin D supplementation in preventing comorbidities.
authors.affiliation: Department of Clinical and Molecular Biomedicine, University of Catania, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Pinzone
authors.forename: M
authors.initials: M
authors.lastname: Di Rosa
authors.forename: M
authors.initials: M
authors.lastname: Malaguarnera
authors.forename: G
authors.initials: G
authors.lastname: Madeddu
authors.forename: E
authors.initials: E
authors.lastname: Focà
authors.forename: G
authors.initials: G
authors.lastname: Ceccarelli
authors.forename: G
authors.initials: G
authors.lastname: d'Ettorre
authors.forename: V
authors.initials: V
authors.lastname: Vullo
authors.forename: R
authors.initials: R
authors.lastname: Fisichella
authors.forename: B
authors.initials: B
authors.lastname: Cacopardo
authors.forename: G
authors.initials: G
authors.lastname: Nunnari
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001847:Bone Diseases / Q000453:epidemiology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014807:Vitamin D