title: Risk factors for vitamin D deficiency among HIV-infected and uninfected injection drug users.
abstract: BACKGROUND
  Vitamin D deficiency is highly prevalent and is associated with bone disease, cardiovascular disease, metabolic syndrome and malignancy. Injection drug users (IDUs), with or without HIV infection, are at risk for these conditions; however, limited data on vitamin D deficiency exist in this population. We determined the prevalence and correlates of vitamin D deficiency among urban IDUs in the AIDS Linked to the IntraVenous Experience (ALIVE) Study cohort.
  
  
  METHODS
  For this cross-sectional sub-study, vitamin D deficiency was defined as a serum 25(OH)-vitamin D level <20 ng/mL. Multivariable logistic regression was used to identify factors independently associated with vitamin D deficiency.
  
  
  RESULTS
  Of 950 individuals analyzed, 29% were HIV-infected. The median age was 49 years; 65% were male, and 91% were black. The median vitamin D level was 13.5 ng/mL (IQR, 9.0-20.3); 74% were deficient (68% in HIV-infected vs. 76% in HIV-uninfected, p = 0.01). Non-black race, fall/winter season, multivitamin intake, higher serum albumin, HCV seropositivity and HIV-infection were associated with significantly lower odds of vitamin D deficiency.
  
  
  CONCLUSIONS
  Vitamin D deficiency is prevalent among IDUs. Notably, HIV-infected IDUs were less likely to be vitamin D deficient. Higher vitamin D levels were associated with multivitamin intake and with higher albumin levels, suggesting that nutritional status contributes substantially to deficiency. The association between HCV serostatus and vitamin D level remains unclear. Further investigation is needed to define the clinical implications of the heavy burden of vitamin D deficiency in this high-risk, aging population with significant co-morbidities.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Lambert
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: M Bradley
authors.initials: MB
authors.lastname: Drummond
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: Department of Medicine, Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America; Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.affiliation: Department of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology*
references.citation: Arch Intern Med. 2008 Jun 9;168(11):1174-80
references.pmid: 18541825
references.citation: J Bone Miner Res. 2011 Jul;26(7):1609-16
references.pmid: 21416506
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30
references.pmid: 21646368
references.citation: Arch Intern Med. 2007 Sep 10;167(16):1730-7
references.pmid: 17846391
references.citation: J Bone Miner Res. 2006 Mar;21(3):397-405
references.pmid: 16491287
references.citation: Am J Clin Nutr. 2007 Sep;86(3):714-7
references.pmid: 17823437
references.citation: AIDS. 2001 Sep 7;15(13):1707-15
references.pmid: 11546947
references.citation: J Clin Endocrinol Metab. 1984 Jul;59(1):86-9
references.pmid: 6547147
references.citation: J Clin Endocrinol Metab. 2013 Mar;98(3):1137-46
references.pmid: 23386641
references.citation: J Clin Endocrinol Metab. 2003 Dec;88(12):5766-72
references.pmid: 14671166
references.citation: JAMA. 1992 Jan 15;267(3):369-73
references.pmid: 1727959
references.citation: J Bone Miner Res. 2003 Feb;18(2):343-51
references.pmid: 12568412
references.citation: AIDS. 2011 Jun 1;25(9):1237-9
references.pmid: 21505299
references.citation: AIDS Patient Care STDS. 2010 Apr;24(4):223-7
references.pmid: 20377437
references.citation: Clin Infect Dis. 2000 Mar;30(3):579-81
references.pmid: 10722447
references.citation: Obes Surg. 2008 Feb;18(2):220-4
references.pmid: 18176832
references.citation: Am J Clin Nutr. 2008 Dec;88(6):1519-27
references.pmid: 19064511
references.citation: Hypertension. 2013 Apr;61(4):779-85
references.pmid: 23487599
references.citation: J Rural Health. 2012 Fall;28(4):356-63
references.pmid: 23017006
references.citation: Am J Med. 2002 Jun 1;112(8):659-62
references.pmid: 12034416
references.citation: Arch Intern Med. 2009 Feb 23;169(4):384-90
references.pmid: 19237723
references.citation: Isr J Med Sci. 1986 Jan;22(1):8-11
references.pmid: 3485617
references.citation: Arch Intern Med. 1979 Mar;139(3):337-9
references.pmid: 426578
references.citation: Nutr Res. 2011 Jan;31(1):48-54
references.pmid: 21310306
references.citation: Clin Infect Dis. 2009 Jan 1;48(1):72-82
references.pmid: 19046064
references.citation: Clin Infect Dis. 2005 Dec 15;41(12):1794-803
references.pmid: 16288406
references.citation: AIDS. 2007 Nov 30;21(18):2473-82
references.pmid: 18025884
references.citation: J Natl Med Assoc. 2011 May;103(5):407-11
references.pmid: 21809790
references.citation: Am J Clin Nutr. 2007 Jun;85(6):1586-91
references.pmid: 17556697
references.citation: Arch Gen Psychiatry. 2007 May;64(5):566-76
references.pmid: 17485608
references.citation: Ethn Dis. 2005 Autumn;15(4 Suppl 5):S5-97-101
references.pmid: 16315387
references.citation: J Hepatol. 2011 May;54(5):887-93
references.pmid: 21145801
references.citation: N Engl J Med. 1990 Sep 27;323(13):878-83
references.pmid: 2203964
references.citation: J Am Geriatr Soc. 2010 Nov;58(11):2063-8
references.pmid: 21054285
references.citation: Infect Dis Clin North Am. 2002 Sep;16(3):697-712
references.pmid: 12371123
references.citation: Hepatology. 2010 Apr;51(4):1158-67
references.pmid: 20162613
references.citation: J Clin Invest. 2006 Aug;116(8):2062-72
references.pmid: 16886050
references.citation: Lancet. 1982 Jan 9;1(8263):74-6
references.pmid: 6119494
references.citation: J Clin Gastroenterol. 2009 Jan;43(1):94-5
references.pmid: 18622303
references.citation: Ann Intern Med. 1993 Nov 15;119(10):1017-28
references.pmid: 8214979
references.citation: Semin Dial. 2004 Nov-Dec;17(6):432-7
references.pmid: 15660573
references.citation: J Bone Miner Res. 2004 Aug;19(8):1221-30
references.pmid: 15231008
references.citation: Arch Intern Med. 2009 Mar 23;169(6):626-32
references.pmid: 19307527
references.citation: Arch Biochem Biophys. 2007 Apr 15;460(2):213-7
references.pmid: 17254541
references.citation: J Nutr. 2005 Oct;135(10):2478-85
references.pmid: 16177216
references.citation: N Engl J Med. 2006 Feb 16;354(7):669-83
references.pmid: 16481635
references.citation: Lancet. 1974 Mar 30;1(7857):536-8
references.pmid: 4131976
references.citation: Clin Infect Dis. 2008 Feb 1;46(3):443-6
references.pmid: 18173355
references.citation: Clin Infect Dis. 2011 Feb 1;52(3):396-405
references.pmid: 21217186
references.citation: Thorax. 1990 Dec;45(12):957-61
references.pmid: 2281430
references.citation: Calcif Tissue Int. 1991 Aug;49(2):84-9
references.pmid: 1655177
references.citation: Am J Cardiol. 2010 Oct 1;106(7):963-8
references.pmid: 20854958
references.citation: Am J Clin Nutr. 2007 Oct;86(4):959-64
references.pmid: 17921371
references.citation: Ann Intern Med. 2010 Mar 2;152(5):307-14
references.pmid: 20194237
references.citation: J Clin Endocrinol Metab. 1988 Aug;67(2):373-8
references.pmid: 2839537
references.citation: J Hypertens. 2009 Oct;27(10):1948-54
references.pmid: 19587609
references.citation: BMJ. 2009 Oct 01;339:b3692
references.pmid: 19797342
references.citation: Br J Nutr. 2010 Feb;103(4):549-55
references.pmid: 19781131
references.citation: J Nutr Health Aging. 2009 Dec;13(10):893-8
references.pmid: 19924350
references.citation: Am J Clin Nutr. 2008 Aug;88(2):558S-564S
references.pmid: 18689402
references.citation: Circulation. 2008 Jan 29;117(4):503-11
references.pmid: 18180395
references.citation: J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):197-204
references.pmid: 21471818
references.citation: JAMA. 2004 Apr 28;291(16):1999-2006
references.pmid: 15113819
references.citation: Nature. 1974 Feb 22;247(5442):563-5
references.pmid: 4818557
references.citation: Kidney Int. 2001 Jul;60(1):333-40
references.pmid: 11422769
references.citation: NIDA Res Monogr. 1991;109:75-100
references.pmid: 1661376
references.citation: AIDS Res Hum Retroviruses. 2009 Jan;25(1):9-14
references.pmid: 19108690