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Risk Factors for Vitamin D Deficiency among HIV-Infected and Uninfected Injection Drug Users  [PDF]
Allison A. Lambert, M. Bradley Drummond, Shruti H. Mehta, Todd T. Brown, Gregory M. Lucas, Gregory D. Kirk, Michelle M. Estrella
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095802
Abstract: Introduction 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.
Vitamin D deficiency in HIV-infected patients: a systematic review  [cached]
Giusti A,Penco G,Pioli G
Nutrition and Dietary Supplements , 2011,
Abstract: Andrea Giusti1, Giovanni Penco2, Giulio Pioli31Bone Clinic, Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Genoa, Italy; 2Department of Infectious Diseases, Galliera Hospital, Genoa, Italy; 3Department of Geriatrics, ASMN Hospital, Reggio Emilia, ItalyAbstract: Advances in the diagnosis and management of human immunodeficiency virus (HIV) have resulted in a dramatic decrease in mortality in HIV-infected individuals (HIV+). The subsequent increase in life expectancy of HIV+ has led to the need to consider the long-term complications of the disease and its treatment. Abnormalities in vitamin D status and metabolism are increasingly recognized as a major concern in HIV infection. In the last 5 years a number of cross-sectional and prospective studies have suggested a high prevalence of vitamin D deficiency in HIV+. Although few case-control studies have been published, it has been suggested that the prevalence of hypovitaminosis D in HIV+ is higher than in the general population, and at least in part, is related to the course of the disease and/or the antiretroviral drugs used to treat the disease. An adequate vitamin D status is important not only for bone tissue, but also for the global health status of HIV+ individuals, since a growing body of evidence has demonstrated the detrimental effects of vitamin D deficiency on multiple health outcomes. Therefore, definition of the size of the problem and identification of effective protocols for the prevention and management of vitamin D deficiency in HIV+ patients represent important steps in improving health status and reducing long-term chronic complications in individuals with HIV. Due to its immunomodulatory effects, vitamin D may also have implications in the progression of HIV infection. This systematic review was designed to determine the prevalence of vitamin D deficiency in HIV+ patients; to identify risk factors (related to the HIV infection or not) potentially associated with this condition; to describe the potential consequences of hypovitaminosis D on the course of the infection and the benefits of vitamin D repletion; and to make some suggestions about the future, considering the limitations of previous studies.Keywords: human immunodeficiency virus, HIV, vitamin D, parathyroid hormone, bone, antiretroviral
Vitamin D deficiency in HIV-infected patients: a systematic review
Giusti A, Penco G, Pioli G
Nutrition and Dietary Supplements , 2011, DOI: http://dx.doi.org/10.2147/NDS.S6921
Abstract: amin D deficiency in HIV-infected patients: a systematic review Review (3130) Total Article Views Authors: Giusti A, Penco G, Pioli G Published Date November 2011 Volume 2011:3 Pages 101 - 111 DOI: http://dx.doi.org/10.2147/NDS.S6921 Andrea Giusti1, Giovanni Penco2, Giulio Pioli3 1Bone Clinic, Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Genoa, Italy; 2Department of Infectious Diseases, Galliera Hospital, Genoa, Italy; 3Department of Geriatrics, ASMN Hospital, Reggio Emilia, Italy Abstract: Advances in the diagnosis and management of human immunodeficiency virus (HIV) have resulted in a dramatic decrease in mortality in HIV-infected individuals (HIV+). The subsequent increase in life expectancy of HIV+ has led to the need to consider the long-term complications of the disease and its treatment. Abnormalities in vitamin D status and metabolism are increasingly recognized as a major concern in HIV infection. In the last 5 years a number of cross-sectional and prospective studies have suggested a high prevalence of vitamin D deficiency in HIV+. Although few case-control studies have been published, it has been suggested that the prevalence of hypovitaminosis D in HIV+ is higher than in the general population, and at least in part, is related to the course of the disease and/or the antiretroviral drugs used to treat the disease. An adequate vitamin D status is important not only for bone tissue, but also for the global health status of HIV+ individuals, since a growing body of evidence has demonstrated the detrimental effects of vitamin D deficiency on multiple health outcomes. Therefore, definition of the size of the problem and identification of effective protocols for the prevention and management of vitamin D deficiency in HIV+ patients represent important steps in improving health status and reducing long-term chronic complications in individuals with HIV. Due to its immunomodulatory effects, vitamin D may also have implications in the progression of HIV infection. This systematic review was designed to determine the prevalence of vitamin D deficiency in HIV+ patients; to identify risk factors (related to the HIV infection or not) potentially associated with this condition; to describe the potential consequences of hypovitaminosis D on the course of the infection and the benefits of vitamin D repletion; and to make some suggestions about the future, considering the limitations of previous studies.
Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia
Andargachew Mulu, Afework Kassu, Kahsay Huruy, Birhanemeskel Tegene, Gashaw Yitayaw, Masayo Nakamori, Nguyen Van Nhien, Assegedech Bekele, Yared Wondimhun, Shigeru Yamamoto, Fusao Ota
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-569
Abstract: In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.Vitamin A deficiency (VAD) is known to be a significant public health problem around the world and it is particularly serious among women of reproductive age in South-East Asia and Africa [1-4]. It has now become evident that VAD in women has negative consequences on their health status as well as on their infants [3,4]. The link between VAD morbidity and mortality from infectious diseases [5] and non-infectious diseases [6-8] has been known for several years.VAD in pregnant women is associated with night blindness, severe anaemia, wasting, malnutrition, and reproductive and infectious morbidity [9], and increased risk of mortality 1-2 years following delivery [4].
Deficiency of Vitamin D in HIV Infected Patients and Its Effect on Some of the Immunological Parameters  [PDF]
Nina Yancheva, Ivaylo Elenkov, Tatyana Tchervenyakova, Ivanka Gabarska, Georgi Kirilov, Maria Nikolova, Marina Alexandrova
World Journal of AIDS (WJA) , 2015, DOI: 10.4236/wja.2015.53021
Abstract: Today the HIV infection is a chronic disease with significantly longer duration of the life of the patients. Problems of pressing interest are the persistent immune activation and chronic inflammation during the treatment with antiretroviral therapy. Taking this into account, different factors which could affect the immune system and the progress of the HIV infection are being researched. Vitamin D (25(OH)D) is one of those factors if we take note of its effect on the innate and acquired immunity. The aim of this study was to assess 25-hydroxyvitamin D (vitamin D) status in one part of the Bulgarian HIV-infected adult population and to assess connection between 25-hydroxyvitamin D (vitamin D) status and plasma levels of some major cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ). The study includes 145 HIV-positive patients, who are being monitored in the Department for acquired immune deficiency at Specialized Hospital for Infectious and Parasitic Diseases “Proff. Ivan Kirov”—Sofia. From all of the monitored patients only in 15% of the tested we found normal 25(OH)D serum levels, and in 12% of the patients we found deficiency. The largest group is that of patients with insufficiency of vitamin D. We didn’t discovered significant difference in the 25(OH)D average values between men and women. There were no significant differences in the average values of the 25(OH)D serum levels when dividing the patients according to their antiretroviral therapy, but after separating the patients by gender, we found that the untreated women had average values of 25(OH)D higher than that of the women treated with EFV. On the next stage of the survey on the 60 HIV-infected patients, who are from the first tested group, we additionally defined the cytokine profile. Our results suggests that increasing 25(OH)D deficiency worsens the damaging of the cellular immune response. The lower levels of vitamin Dare associated with increased levels of IL-6, decreased levels of IL-10, IFN-γ and TNF-α. There’s active immune inflammation when there are reduced 25(OH)D serum levels and it leads to stimulated secretion of the regulatory cytokines and suppression of the Th1 antiviral response. The phase of advanced 25(OH)D deficiency is characterized by parallel depletion of the regulatory and effecter capabilities of CD4 lymphocytes. The recovery of the CD4 lymphocyte pool is difficult because of the lower than average 25(OH)D serum levels, regardless of the conducted antiretroviral therapy.
Prevalence and Factors Associated with Vitamin D Deficiency and Hyperparathyroidism in HIV-Infected Patients Treated in Barcelona  [PDF]
Elisabet Lerma,M. Ema Molas,M. Milagro Montero,Ana Guelar,Alicia González,Judith Villar,Adolf Diez,Hernando Knobel
ISRN AIDS , 2012, DOI: 10.5402/2012/485307
Abstract: Vitamin D deficiency is an important problem in patients with chronic conditions including those with human immunodeficiency virus (HIV) infection. The aim of this cross-sectional study was to identify the prevalence and factors associated with vitamin D deficiency and hyperparathyroidism in HIV patients attended in Barcelona. Cholecalciferol (25OH vitamin D3) and PTH levels were measured. Vitamin D insufficiency was defined as 25(OH) D < 20?ng/mL and deficiency as <12?ng/mL. Hyperparathyroidism was defined as PTH levels >65?pg/mL. Cases with chronic kidney failure, liver disease, treatments or conditions potentially affecting bone metabolism were excluded. Among the 566 patients included, 56.4% were exposed to tenofovir. Vitamin D insufficiency was found in 71.2% and 39.6% of those had deficiency. PTH was measured in 228 subjects, and 86 of them (37.7%) showed high levels. Adjusted predictors of vitamin D deficiency were nonwhite race and psychiatric comorbidity, while lipoatrophy was a protective factor. Independent risk factors of hyperparathyroidism were vitamin D < 12?ng/mL (OR: 2.14, CI 95%: 1.19–3.82, P: 0.01) and tenofovir exposure (OR: 3.55, CI 95%: 1.62–7.7, P: 0.002). High prevalence of vitamin deficiency and hyperparathyroidism was found in an area with high annual solar exposure. 1. Introduction Vitamin D is a steroid liposoluble hormone and can be made available to the individuals in two forms. First, vitamin D3 or cholecalciferol is synthesized in the skin in response to ultraviolet B radiation and is present in oil-rich fish (salmon, mackerel, and herring), egg yolks, and liver [1]. Second, vitamin D2 or ergocalciferol is obtained from the UV irradiation of the yeast sterol ergosterol and is found in sun-exposed mushrooms [2]. Both vitamins undergo identical metabolism, and as they are biologically inert, they require two hydroxylations, in the liver and in the kidney, to become 1,25dihydroxyvitamin D [1,25(OH)2D] which is the biologically active form of the hormone [3, 4]. In the intestine this stimulates the absorption of calcium and phosphorus, and it helps to regulate the metabolism of both minerals within bone and kidney interaction [5]. Assessment of vitamin D is based on measurement of serum 25(OH)D [6, 7] that is the most stable and plentiful metabolite of vitamin D in serum and has a half-life about 21 days [8]. The main source of vitamin D is exposure to sunlight [9, 10]. Therefore, an insufficient exposure to sunlight is a major cause of vitamin D deficiency. Other causes of vitamin deficiency are sunscreen sun protection [2],
Vitamin D deficiency in HIV-infected individuals: one more risk factor for bone loss and cardiovascular disease?
Conrado, Tereza;Miranda-Filho, Demócrito de Barros;Bandeira, Francisco;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2010, DOI: 10.1590/S0004-27302010000200006
Abstract: the epidemiological profile of the hiv virus has undergone substantial modifications with advances in antiretroviral therapy. there has been a sharp decline in morbi-mortality levels of hiv-infected patients, which has resulted in higher survival rates. the hiv seropositive population is living longer and more exposed to chronic complications caused by the disease itself and the prolonged use of antiretrovirals. initially, metabolic alterations were reported, increasing cardiovascular disease risk. subsequently, damage on bone metabolism was related. vitamin d insufficiency has now reached epidemic proportions, even in healthy individuals living in the tropics. recent data suggest the hypovitaminosis d association with metabolic syndrome, immune diseases, diabetes and hypertension. little is known regarding the effects of hiv/aids and its treatment on the metabolism of vitamin d. in hiv-positive patients, factors linked to the virus itself and the use of antiretrovirals may be added to the other causes of hypovitaminosis d.
Vitamin D status in an urban Spanish HIV-infected patient cohort and its relationship with most frequent antiretroviral therapy regimens
M Cervero,J Agud,R Torres,J Jusdado
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18323
Abstract: Purpose: We assessed vitamin D status in HIV-infected patients and its relation to classic, related-HIV risk factors and therapeutic regimens. Methods: Out of 450 HIV-infected patients followed in the H. Severo Ochoa (Madrid, Spain), we selected 352 patients in which vitamin D levels had been assessed (2009 to 2010). We describe demographics, cART duration, cART, viral load (VL), CD4+ cell count, 25(OH)D levels, iPTH, MDRD, serum albumin and calcium. Vitamin D status cutoff points were: 1. deficiency (vitDd): 25(OH)D levels <20 ng/mL; 2. insuficiency (vitDi): 20 to 29.99 ng/mL and 3. optimal (vitDo): 25(OH)D ≥ 30 ng/mL. Results: Median CD4+ cell count was 501 cells/μL; median VL 40 copies/mL. 277 patients (78.7%) had less than 50 copies/mL. 310 patients (88.1%) were on cART. The proportions of patients with vitDd, vitDi and vitDo were 155/352 (44%), 97 (27.6%) and 100 (28.5%). Black patients had 14.2% of vitDd (22 patients out of 155 patients with vitDd), 7.2% (7/97) vitDi and 1% (1/100) vitDo (p=.001) vs. global sample; therefore, 29 out of 30 (96.7%) black patients had vitDd/vitDi, vs. 71.6% in global sample. Former IDUs had more vidDo (p<0.001 vs. other risk groups). Among patients with less than 50 copies/mL, the proportions of vitDd, vitDi and vitDo were 77.4%, 68% and 91% respectively, (p=.0001). Of the cART, only PI monotherapy was associated with significant differences in vitD (see Table). On multivariate analysis following variables were related to increased risk of vitD insuficiency/deficiency, black vs. white race (OR 10.6 [95% CI 1.2–94], p=.033); heterosexual/MSM risk vsm IDU risk groups (OR 2.37 [95% CI 1.13–4.93], p=.022) and (OR 3.25 [95% CI 1.25–8.50], p=.016) and VL>50 copies/mL (OR 2.56 [95% CI 1.10–7.25], p=.040). Less risk of vitamin D insufficiency/deficiency was found in patients on PI monotherapy vs. no treatment (OR 0.08 [95% CI 0.01–0.6], p=.018); Hispanic (South American) patients vs. white (OR 0.18 [95% CI 0.05–0.68], p=.012) and summer/autumn vs. spring samples (OR 0.015 [95% CI 0.002–0.116], p=.0001 summer) and (OR 0.013 [95% CI 0.02–0.099), p=.0001, for autumn). Conclusions: 1: Vitamin D status was associated with ethnic background, season and non-suppressed VL. 2: Former IDUs had less vitamin D deficiency/insufficiency, perhaps due to more outdoor jobs. 3: As in the MONET study, PI monotherapy had a positive impact on vitD.
Prevalence of vitamin D deficiency in human immunodeficiency virus-infected patients  [cached]
V Fridman,N Bello,E Godoy,D Stecher
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18324
Abstract: Purpose of the study: Vitamin D deficiency in the adults could produce osteomalacia, secondary hyperparathyroidism with bone loss and increased risk of fractures. An increased prevalence of osteopenia, osteoporosis, decreased bone density, vitamin D deficiency and increased risk of fracture was found in HIV-positive patients. A study performed in Buenos Aires, Argentina that included non-HIV-infected adult patients showed 15% prevalence of vitamin D deficiency in winter and 0% prevalence in summer. There is no local data published of vitamin D deficiency in HIV-positive populations. The aim of the study is to determinate the prevalence of vitamin deficiency in our HIV-positive population receiving HAART. Methods: An observational, retrospective study was performed. We reviewed the clinical charts of the HIV-positive adult patients attending the infectious disease clinic. We collected data of vitamin D, parathormone and beta cross laps value; we recorded if the test was performed in winter or summer. We considered vitamin D deficiency if<10 ng/ml. We recorded age, sex, comorbidities (diabetes mellitus, renal failure, hepatic failure, HBV and/or HCV coinfection, menopause, malignancy and metabolic syndrome), months since HIV diagnosis, CD4 count, viral load and HAART. Summary of results: 60 patients were included, 49 (65%) of whom were male. Mean age was 49.15 years. Mean time from diagnosis was 112 months. Mean CD4 count was 548 cells/mm3 and 6.6% presented CD4 <200; 83.3% had viral load <50 copies/mm3. All patients were on HAART; 50% received efavirenz, 65% received tenofovir and 11.6% recived atazanavir. Mean vitamin D value was 23.58 ng/ml (5–66.5 ng/ml). In winter, 15.3% of the patients had <10 ng/ml of vitamin D and mean value was 24.16 ng/ml (10–40 ng/ml). Although the mean value in summer was 25.8 ng/ml (11.6–66 ng/ml) 10% of the patients had vitamin D deficiency. PTH value was abnormal in 31.6% of patients and beta cross laps was abnormal in 10% of patients. Conclusions: Although the small number of patient included, we observed a high prevalence of vitamin D deficiency even in summer. A systematic assessment of vitamin D must be included in HIV positive patient care.
Cholecalciferol supplementation, vitamin D status and T-cell immune phenotype in HIV-infected children: a randomised controlled trial
A Vigano,V Giacomet,V Manfredini,G Bedogni
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18231
Abstract: Purpose of the study: Besides its known effects on bone metabolism, vitamin D may regulate immune function. We performed a randomized controlled trial (RCT) to test whether cholecalciferol supplementation can improve vitamin D status and modulate immune responses in HIV-infected children and youth. Methods: Caucasian vertically HIV-infected patients (aged 8 to 26 years) with vitamin D deficiency and normal parathormone (PTH) levels were randomized into an experimental (n=25) and control (n=25) group to receive 100,000 IU of oral cholecalciferol every 3 months for a total of 4 doses, or placebo. A pre-randomization period ( 3 months) was also taken into account to better model within-individual variability. Mixed linear regression models were used to evaluate the between-group changes in the outcomes of interest. The analysis was intention to treat. Summary of results: 47 subjects completed the RCT. Cholecalciferol supplementation produced an early decrease in PTH levels (3 months) and a later concomitant increase in 25(OH)D and 1,25(OH)2D levels (6 months), both persisting up to 12 months.The supplementation had no effect on CD4+T-cell numbers or percentage while was associated with a decreased loge Th1, an increased loge Th2 (*p<0.05), an increased loge Treg (**p<0.01), and and a decreased loge Th17:Treg(*p<0.05). Conclusions: In our cohort, supplementation with oral cholecalciferol was effective in increasing serum 25(OH)D and 1–25(OH)2D while decreasing serum PTH levels, had no effect on CD4+T-cell count, but was associated with T-cell phenotype changes mainly favoring Tregulatory subset.
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