title: Decline in serum 25 hydroxyvitamin D levels in HIV-HBV-coinfected patients after long-term antiretroviral therapy.
abstract: BACKGROUND
  Vitamin D insufficiency plays an important role in the development of fibrosis in chronic liver disease.
  
  
  METHODS
  This was a cross-sectional study from Thailand. Liver fibrosis was assessed by transient elastography. Serum 25 hydroxyvitamin D (25[OH]D)<30 ng/ml was defined as hypovitaminosis D. 25(OH)D was assessed prior to and following tenofovir disoproxil fumarate (TDF). Factors related to 25(OH)D levels were determined by logistic regression analysis.
  
  
  RESULTS
  A total of 158 HIV-HBV-coinfected patients (32% female, median age 43 years) were included. Overall, liver disease was mild with 13.4% having a fibrosis score (FS) of 7.1-14 kPa and 2% with a FS>14 kPa. Median (IQR) duration on TDF was 5 years (4-7). The median estimated glomerular filtration rate was 96.9 ml/min/1.73 m(2). The median (IQR) serum 25(OH)D levels prior to and following TDF were 24.8 ng/ml (21.3-30.6) and 22.8 ng/ml (18.0-27.7), respectively; P≤0.001). The proportion of patients with hypovitaminosis D significantly increased from 72.2% (95% CI 64.7, 78.6) prior to TDF to 84.2% (95% CI 77.7, 89.0) after taking TDF (P=0.01). Factors associated with hypovitaminosis D by multivariate analysis were female sex (adjusted OR 3.8, 95% CI 1.1, 13.7; P=0.038) and duration of antiretroviral therapy (ART)>5 years (OR 3.3, 95% CI 1.2, 8.8; P=0.017). Vitamin D levels were not associated with significant liver fibrosis.
  
  
  CONCLUSIONS
  Although our HIV-HBV-coinfected patients live in the tropics, there was a high prevalence of hypovitaminosis D, especially in female patients and those receiving prolonged ART. Since HIV-HBV-coinfection requires long-term use of the HBV-active drug, TDF, which can also contribute to bone loss, routine vitamin D assessment and supplementation as necessary should be considered.
authors: HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors: Anchalee
authors: A
authors: Avihingsanon
authors: Tanakorn
authors: T
authors: Apornpong
authors: Reshmie A
authors: RA
authors: Ramautarsing
authors: Sasiwimol
authors: S
authors: Ubolyam
authors: Pisit
authors: P
authors: Tangkijvanich
authors: Jintanat
authors: J
authors: Ananworanich
authors: Joep M A
authors: JM
authors: Lange
authors: Gail
authors: G
authors: Matthews
authors: Sharon R
authors: SR
authors: Lewin
authors: Kiat
authors: K
authors: Ruxrungtham
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D006509:Hepatitis B / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D006801:Humans; D017674:Hypophosphatemia / Q000150:complications; D007677:Kidney Function Tests; D007687:Kidney Tubules, Proximal / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013785:Thailand; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D