Vitamin D status in an urban Spanish HIV‐infected patient cohort and its relationship with most frequent antiretroviral therapy regimens

Abstract

PurposeWe assessed vitamin D status in HIV‐infected patients and its relation to classic, related‐HIV risk factors and therapeutic regimens.MethodsOut 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.ResultsMedian 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). vitDd n=155 (44%) vitDi n=97 (27.6%) vitDo n=100 (28.4%) p Age 28 (23–34) 28 (25–35) 27 (23–35) 0.77 Gender n (%) Female/male 59 (38.1%) 96 (61.6%) 23 (23.7%) 74 (76.39%) 34 (34%) 66 (66%) 0.06 Ethnic background n (%) Caucasian/Black/Hispanic 125 (80.6%) 22 (14.2%) 8 (5.2%) 83 (85.6%) 7 (7.2%) 7 (7.2%) 91 (91%) 1 (1%) 8 (8%) 0.07 0.001* 0.64 Risk factor HTX/MSM/IDU/other 76 (49.1%) 18 (11.6%) 59 (38.1%) 2 (1.3%) 34 (35.1%) 27 (27.8%) 33 (34%) 3 (3.1%) 27 (27%) 9 (9%) 63 (63%) 1 (1%) 0.001* 0.0001* 0.0001* 0.45 Calcium (mg/dL) 9.3 (9–9.6) 9.2 (8.5–9.5) 9.2 (8.9–9.5) 0.08 Albumin (g/dL) 4.4 (4.2–4.6) 4.4 (4.1–4.6) 4.4 (4.2–4.6) 0.59 iPTH (pg/mL) 48.2 (34.2–67.8) 46 (32.8–59.45) 45.2 (34.57–59.9) 0.51 Phosphorus (mg/dL) 3.29 (3.1–3.6) 3.296 (2.9–3.3) 3.296 (3–3.296) 0.053 Glomerular filtration rate (MDRD) 88.2 (77.3–102) 85.9 (74.7–95.5) 84 (73.9–92.3) 0.03 GFR <60 n (%) 6 (3.9%) 1 (1%) 9 (9%) 0.02 Blood glucose (mg/dL) 96 (88–104) 96 (89–104) 97 (89–104) 0.99 HCV (%) 92 (59.4%) 58 (59.8%) 33 (33%) 0.0001* HBV (%) 3 (1.9%) 6 (6.2%) 4 (4%) 0.22 CD4+ 519 (334–700) 449 (307–637) 505 (360–660) 0.36 HIV copies/mL (%)>50<50 35 (22.6%) 120 (77.4%) 31 (32.4%) 66 (68%) 9 (9%) 91 (91%) 0.0001* HAART, n (%) 73 (47.1%) 45 (46.4%) 67 (67%) 0.003* Season, n (%) spring/summer/ autumn/winter 52 (33.5%) 20 (12.9%) 35 (22.6%) 48 (31%) 15 (15%) 25 (25.8%) 38 (39.2%) 19 (19.6%) 1 (1%) 37 (37%) 58 (58%) 4 (4%) 0.0001* 0.0001* 0.0001* 0.0001* HAART regimens (patients with <50 copies) vitDd n= 118 VitDi n=64 VitDo n=91 Duration (months) 85 (40–143) 64 (28–138) 86 (43–140) 0.344 NNRTI+TDF 36 (30.51%) 23 (35.94%) 21 (23.07%) 0.258 NNRTI+no_TDF 16 (13.56%) 8 (12.5%) 9 (9.89%) 0.745 PI+TDF 28 (23.73%) 15 (23.44%) 25 (27.47%) 0.728 PI+no−TDF 14 (11.28%) 9 (14.06%) 15 (16.48%) 0.602 NNRTI+PI+TDF 1 (0.85%) 0 (0%) 0 (0%) 0.519 NNRTI+PI+no−TDF 3 (3%) 1 (1.56%) 3 (3.29%) 0.781 Other+TDF 2 (2.54%) 1 (1.56%) 0 (0%) 0.475 Other+no TDF 9 (7.63%) 5 (7.81%) 5 (5.49%) 0.821 PI monotherapy 9 (7.63%) 2 (3.12%) 13 (14.28%) 0.039* 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).Conclusions1: 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.