02/18/10

PRN Report from 17th CROI:  Vitamin D and HIV

Vitamin D insufficiency and deficiency has been associated with multiple pathologies in the human body including rheumatoid arthritis, cardiovascular disease, hypertension, and insulin resistance/diabetes. Interesting data regarding the increased rates of vitamin D insufficiency and deficiency in patients infected with HIV were presented and discussed in a themed session Wednesday at CROI 2010 in San Francisco.

Dr. Christine Dao from the CDC in Atlanta, GA presented data from the Study to Understand the Natural History of HIV (SUN) which accessed levels of vitamin D [25(OH) D] and factors that were associated with these low levels. SUN study data showed that 71.6% of patients were insufficient of 25(OH) D. Factors that were independently associated with lower levels of 25(OH) D included black or Hispanic ethnicity, lack of exercise, low rates of UV exposure, and the presence of hypertension as a comorbid condition. Interestingly, exposure to efavirenz as part of antiretroviral therapy (ART) was also independently associated with lowered levels of 25(OH) D. Efavirenz induces cytochrome P450 to increase the turnover of 25(OH) D to 1,25(OH) D leading to insufficiency of 25(OH) D.

Data from Italy echoed the significant prevalence of 25(OH) D insufficiency in HIV infected individuals. Dr. A d’Arminio Monforte presented data which compared levels of vitamin D in patients before and after starting ART. 54% of the patients sampled were found to be 25(OH) D insufficient and levels of 25(OH) D decreased at a rate of nearly 8nmol/year. These data also noted that exposure to non-nucleoside reverse transcriptase inhibitors as part of ART was associated with higher levels of 25(OH) D insufficiency.

Prevalence of insufficiency and deficiency occurs at high rate in patients with HIV infection and increases with exposure to ART. These data suggest that patient with HIV should be screened for low levels of 25(OH) D and supplementation should be considered, particularly as patients remain on ART for longer periods of time.

Reference:
Christine Dao et al. Assessment of Vitamin D Levels among HIV-Infected Persons in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy: SUN Study. Presented at 17th Conference on Retroviruses and Opportunistic Infections; San Francisco, CA. Themed Discussion 750.

Marco Borderi et al. Prevalence of Hypovitaminosis D among HIV + Patients Enrolled in a Large Italian Cohort. Presented at 17th Conference on Retroviruses and Opportunistic Infections; San Francisco, CA. Themed Discussion 751.

Source: Reporting from San Francisco for PRN News: A.C. Demidont, DO