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Highly prevalent vitamin D deficiency and insufficiency among an urban cohort of human immunodeficiency virus (HIV)-infected men under care
D. Rubin1,2, P. Wasserman1
1New York Hospital Queens, Infectious Disease Division, Department of Medicine, New York, United States, 2Weill Cornell Medical College, New York, United States
Background: Inadequate vitamin D may contribute to chronic disease. We investigated serum Vitamin D levels of men under care.
Methods: Prospective period prevalence study, November 20, 2008 to January 22, 2009, conducted in private practice at latitude N 40, 46 minutes. Men presenting for routine follow-up without clinical disease or use of medications known to interfere with vitamin D metabolism were evaluated. Age, ethnicity, HIV risk factor, history wasting, tobacco/vitamin use, time since diagnosis HIV infection and initiation combination antiretroviral therapy (cART), current receipt: protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI) were determined. Nutriture was evaluated by body mass index (BMI) and mid-upper arm circumference (MUAC). Serum 25-[OH] vitamin D, CD4 cell count and viral load (VL) were assayed. Vitamin D deficiency was defined as < 50 nmol/L (20ng/dl), severe deficiency < 25 nmol/L (10ng/dl) and insufficiency > 50 nmol/L but < 75 nmol/L (30 ng/dl).
Results: 62 men, 77% MSM, 91.9% receiving cART (91.2% VL < 200), 46.8% Hispanic, 33.9% white, 16.1% black, 30.7% receiving NNRTI and 59.7% PI. Median: age 48 years, BMI 26.4, MUAC percentile 25, time since diagnosis 12 years, duration cART 9 years, CD4 541(25%) 0.63. VL < 200 83.9%. Overall, 41.9 % vitamin D deficient (11.3% severe deficiency), 33.9% insufficient and 24.2% sufficient, P= < 0.0001. Median vitamin D: 42.4 versus 64.9 nmol/L NNRTI and PI recipients, respectively, P = 0.0017. Deficient %: 73.7 (14/19) NNRTI versus 29.7 (11/37) PI recipients, P=0.0017 OR 6.62 (95% CI 1.91-22.89). Tobacco use correlated with severe deficiency P=0.032. There were no correlations with ethnicity, history wasting, current CD4 or nutritional parameters.
Conclusions: Vitamin D deficiency and insufficiency were highly prevalent among asymptomatic HIV-infected men receiving cART. Routine clinical screening may be of value. NNRTI receipt may be associated with deficiency and is an area for future research.
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