Author: Mark Mascolini
30 July 2010
Current efavirenz use doubled the risk of severe vitamin D deficiency in HIV-positive people attending a London clinic. Current vitamin D and current tenofovir raised the risk of increased alkaline phosphatase, a marker of bone turnover.
Vitamin D is essential for healthy bones and possibly for immune system health. Previous studies found low vitamin D levels in people with HIV, but the clinical meaning of these findings—and the impact of antiretroviral therapy—remain unclear.
This analysis involved 1077 people in whom 25(OH)D levels were measured once in a London HIV clinic. The investigators defined severe vitamin D deficiency as a 25(OH)D level below 25 mmol/L. Almost everyone seen, 91%, had suboptimal vitamin D levels, and one third had severe deficiency.
Severe vitamin D deficiency proved more likely in blacks, in people with a lowest-ever CD4 count below 200 cells/μL, and in winter. An analysis restricted to people taking antiretrovirals determined that current efavirenz doubled the risk of severe deficiency independently of other factors (adjusted odds ratio [AOR] 2.0, 95% confidence interval [CI] 1.5 to 2.7).
Current tenofovir use more than tripled the risk of high alkaline phosphatase (in the upper 25% for patients studied) (AOR 3.5, 95% CI 2.3 to 5.2). Current efavirenz use raised the risk of high alkaline phosphatase by 60% (AOR 1.6, 95% CI 1.02 to 2.4). However, severe vitamin D deficiency did not correlate with increased bone turnover in this analysis.
The authors call for further research on these issues, in part because efavirenz and tenofovir are such widely prescribed antiretrovirals. Recent work reported at the XVIII International AIDS Conference found no correlation between use of efavirenz or any other antiretroviral and vitamin D deficiency among 312 HIV-positive people in a different London clinic (Rashid et al, reference below). At the same meeting, analysis of 1750 women in the US Women’s Interagency HIV Study found high rates of vitamin D deficiency, but rates were lower in women with HIV than in cohort members without HIV (Adeyemi et al, reference below).
Sources:
Tanya Welz, Kate Childs, Fowzia Ibrahim, Mary Poulton, Chris B. Taylor, Caje F. Moniz, Frank A. Post. Efavirenz is associated with severe vitamin D deficiency and increased alkaline phosphatase. AIDS. 2010; 24: 1923-1928.
T. Rashid, E. Devitt, S. Mandalia, et al. No association of vitamin D levels with individual antiretroviral agents, duration of HIV-infection, alkaline phosphatase levels nor bone mineral density findings. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPDB105.
O.M. Adeyemi, D. Agniel, A. French, et al. High rates of vitamin D deficiency among HIV-infected at at-risk women in the United States. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPDB101.
For the Welz article
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XVIII International AIDS Conference abstracts are online here. Click on Progamme-at-a-Glance, then on Abstract, then search for the abstract number.