Abstract
Objective: Due to the lack of studies assessing hypovitaminosis D and secondary hyperparathyroidism in Brazilian HIV-infected population, especially in the northeastern population, this study aimed to determine the profile of these conditions in patients infected with HIV and its correlation with immuno-virological, sociodemographic data and associated comorbidities. Methods: Comparison studies were obtained from routine clinical samples of HIV infected patients submitted for 25-OH Vitamin D, PTH and alkaline phosphatase determination. Results: A total of 78 patients were included, 42 (53.8%) males, mean age 45.7 years. Antiretroviral regimens most used in this study were Zidovudine/Lamivudine/Efavirenz 17.9%, Tenofovir/Lamivudine/Efavirenz 17.9%,Tenofovir/Lamivudine/Atazanavir-r 15.4%. The mean value CD4 count was 592.1 ± 247.2 cells/mm3, CD8 cell count was 1026.5 ± 467.3 cells/mm3, mean detectable viral load was 2220 ± 15703 copies and CD4/CD8 ratio was 0.63 ± 0.33. A total of 34 vitamin D dosages were collected with 41.2% representing sufficient amount and 58.8% insufficient. Alkaline Phosphatase (ALP) dosage was elevated in 49.3% (N=35) of the patients. Parathormone (PTH) was elevated in 18% (N = 11). Among patients with elevated PTH levels, 81.9% had elevated levels of ALP (p = 0.01). In the group of patients with high levels of ALP, 45.7% had a CD4 count 3 (p = 0.02). There was no significant difference in vitamin D related to gender (p = 0.21), age (p = 0.23), CD4 count (p = 0.26), suppressed viral load (p = 0.44) or blood glucose (p = 0.45). Conclusions: This study evidenced a high prevalence of Vitamin D insufficiency in Northeast Brazil, which suggests HIV infection correlation. A high prevalence of Hyperparathyroidism was detected and related with inflammatory condition persistence and low CD4 count. We suggest improve vitamin D follow up and measurements in this population with better CD4 count control to avoid future osteoarticular complications of HIV treatment.
Highlights
According to the United Nations Program on HIV/AIDS (UNAIDS), around 35 million people were living withHIV, 2.1 million have been infected by the virus and 1.5 million died in 2013 [1]
Data were collected through a form containing sociodemographic, immuno-virological, antiretroviral therapy, blood glucose, vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP), and comorbidities related, as osteoarticular diseases and tuberculosis
Studies conducted in different parts of the world evidenced inadequate levels of vitamin D in most patients with HIV infection, including developed countries as United States, as The Women’s Interagency HIV Study (WIHS) study demonstrated a 60% prevalence of hypovitaminosis D [14]
Summary
According to the United Nations Program on HIV/AIDS (UNAIDS), around 35 million people were living withHIV, 2.1 million have been infected by the virus and 1.5 million died in 2013 [1]. Under the advent of antiretroviral therapy (ART), the number of new infected persons, the onset of opportunistic infections and mortality in HIV patients had a large reduction [3]. This view attended to new health problems in the population living with HIV, such as higher prevalence of cardiovascular diseases, diabetes mellitus [4], acute myocardial infarction [5] [6] and heart failure [7]. Disturbances such as hypovitaminosis D had been related [8] [9]
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