Vitamin D Insufficiency in HIV-Infected Patients

"Vitamin D insufficiency was slightly less common in HIV-infected patients than in the general U.S. population. The clinical significance of this insufficiency remains uncertain.

Vitamin D deficiency is associated with a broad range of disorders, many of which are also linked to HIV infection and its treatment. However, little is known about the prevalence or predictors of low vitamin D levels among HIV-infected adults.

To address this gap, researchers evaluated laboratory, clinical, and behavioral data from 672 HIV-infected patients who were part of a larger U.S. cohort study and were not receiving vitamin D supplementation. Vitamin D insufficiency was defined as a 25-hydroxyvitamin D level <30 ng/mL, and prevalence estimates were standardized by age, sex, and race.

Seventy percent of the HIV-infected population was estimated to have vitamin D insufficiency. By comparison, the estimated prevalence in the general U.S. population, based on NHANES data, was 79%. In a multivariate analysis, Hispanic or black race, lack of exercise, higher body-mass index, hypertension, and use of efavirenz were all independently associated with vitamin D insufficiency. A glomerular filtration rate <90 mL/minute/1.73 m², use of ritonavir, and greater exposure to ultraviolet light were independently associated with a lower likelihood of vitamin D insufficiency.

Comment: The finding of a slightly lower prevalence of vitamin D insufficiency in the HIV-infected population than in the general population is somewhat surprising, although the prevalence in both groups is high. Given that the clinical significance of this insufficiency (especially in its mildest form) is poorly defined in virtually all populations, the observed associations with various HIV treatments do not, at this point, warrant any changes in screening or management. HIV clinicians can simply join providers from other fields in wondering what to do about measurement of or supplementation with this "vitamin du jour."

— Eileen Scully, MD, PhD, and Paul E. Sax, MD

Dr. Scully is a Fellow in the Division of Infectious Diseases at Brigham and Women's Hospital in Boston. She reports no conflicts of interest.

Published in Journal Watch HIV/AIDS Clinical Care February 7, 2011

CITATION(S):

Dao CN et al. Low vitamin D among HIV-infected adults: Prevalence of and risk factors for low vitamin D levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clin Infect Dis 2011 Feb 1; 52:396.