association of vitamin D levels with individual antiretroviral agents, duration
of HIV-infection, alkaline phosphatase levels nor bone mineral density findings
Presented by Emma Devitt (United Kingdom).
T. Rachid, E. Devitt, I. Meyron, S. Mandalia, L. Waters, M. Bower, R. Jones, M. Nelson
Chelsea and Westminster Hospital, HIV Medicine, London, United Kingdom
Bone health has emerged as an area of concern in individuals living with HIV. The aim of this study was to investigate the prevalence of and identify risk factors for vitamin D deficiency in a large HIV cohort.
Consecutive patients attending the HIV clinic in July 2009 had 25(OH) vitamin D levels. Data were collected retrospectively detailing gender, ethnicity, age, current treatment regimen, HIV viral load, CD4 count and duration of infection.
Vitamin D levels were defined as normal when >70nmol/L, low 40-70nmol/L, deficient < 40nmol/L. SAS statistical package version 9.1 was used for linear regression analysis.
312 consecutive patients with mean age 48 years(25-83) were identified. 88% were male. Mean duration of HIV infection 12 years(0-26).
Median vitamin D level was 66nmol/L (range < 10-221), 109(35%) were defined as low and 64(21%) were defined as deficient. Vitamin D levels below the normal range were correlated with non-caucasian ethnicity (p< 0.001) and female sex (p< 0.001). There was no association with any antiretroviral class or specific agent, including efavirenz. Individuals with low vitamin D levels were not more likely to have a raised alkaline phosphatase level. In total, 102 patients (33%) had undergone bone mineral density measurement within the last six months for unrelated reasons. Median vitamin D levels were 71, 71 and 58nmol/L for those with normal, osteopaenic and osteoporotic results respectively.
In this study, we could find no association of low vitamin D with any drug class or individual agent, which is in contrast to the findings of several other studies. The only associations identified were with classical risk factors of sex and race. The lack of association of low vitamin D levels with alkaline phosphatase level and bone mineral density findings brings into question the utility of this test as part of routine HIV care.
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