title: The Association of Gender, Age, Efavirenz Use, and Hypovitaminosis D Among HIV-Infected Adults Living in the Tropics.
abstract: Vitamin D, which is important for calcium homeostasis and bone metabolism, has several noncalcemic actions. Low vitamin D levels have been observed in HIV-infected patients from high latitudes, with consequently reduced bone mineral density (BMD), but data from the tropics are scarce. We aimed to determine the prevalence of and risk factors for hypovitaminosis D among HIV-infected patients in the tropics. This was a cross-sectional study to determine serum 25-hydroxyvitamin D [25(OH)D] levels in HIV-infected patients who attended our HIV clinic in Bangkok, Thailand from July 2010 to June 2011. Hypovitaminosis D was defined as vitamin D insufficiency and deficiency [25(OH)D 20-30 ng/ml and <20 ng/ml, respectively]. Hypovitaminosis D prevalence was calculated and risk factors were determined using multivariate logistic regression. A total of 673 HIV-infected adults were included. The median age was 41 years and 47% were females. The median body mass index (BMI) was 21.9 kg/m(2) and 93% were using antiretroviral therapy (ART), with a median (IQR) duration of 8.9 (5.0-10.4) years. Thirty-one percent were using efavirenz (EFV). The prevalence of vitamin D insufficiency and deficiency was 40.6% and 29.9%, respectively. In multivariate analysis, female gender [odds ratio: OR (95% confidence interval: 95% CI) 1.7 (1.2-2.3), p = 0.005], age >37 years [OR (95% CI) 1.6 (1.1-2.4), p = 0.01], and EFV use [OR (95% CI) 2.0 (1.3-3.2), p = 0.004] were independent predictors of hypovitaminosis D. Even in tropical areas where the sun is abundant, hypovitaminosis D is highly prevalent. Thus, treatment of low vitamin D in HIV-infected patients at high risk should not be ignored to prevent reductions in BMD and other hypovitaminosis D-related comorbidities.
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .|2 Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .|3 The Kirby Institute, The University of New South Wales , Sydney, Australia .
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .|4 Department of Global Health, Academic Medical Center, University of Amsterdam , Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, the Netherlands .
authors.forename: Reshmie A
authors.initials: RA
authors.lastname: Ramautarsing
authors.affiliation: 5 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Sophonphan
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
authors.forename: Sasiwimol
authors.initials: S
authors.lastname: Ubolyam
authors.affiliation: 5 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
authors.affiliation: 6 Hormonal and Metabolic Disorders Research Unit and Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Weerapan
authors.initials: W
authors.lastname: Khovidhunkit
authors.affiliation: 7 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Narin
authors.initials: N
authors.lastname: Hiransuthikul
authors.affiliation: 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre , Bangkok, Thailand .|2 Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D013785:Thailand / Q000453:epidemiology; D014329:Tropical Climate; D014808:Vitamin D Deficiency / Q000453:epidemiology*
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz