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BackgroundEven though it has been suggested that antiretroviral therapy has an impact on severe hypovitaminosis D (SHD) in HIV infected patients, it could be speculated that the different levels of residual inflammation on HAART (Highly Active Anti Retroviral Therapy) could contribute to SHD and aggravate bone catabolism in these patients.MethodsA cross-sectional study was carried out in an unselected cohort of 263 HIV infected outpatients consulting during Spring 2010. Clinical examinations were performed and medical history, food habits, sun exposure and addictions were collected. Fasting blood samples were taken for immunological, virological, inflammation, endocrine and bone markers evaluations.ResultsNinety-five (36%) patients had SHD. In univariate analysis, a significant and positive association was found between SHD and IL6 (p = 0.001), hsCRP (p = 0.04), increased serum C-Telopeptides X (CTX) (p = 0.005) and Parathyroid Hormon (PTH) (p < 0.0001) levels. In multivariate analysis, SHD deficiency correlated significantly with increased IL-6, high serum CTX levels, lower mean daily exposure to the sun, current or past smoking, hepatitis C, and functional status (falls), but not with the time spent on the current HAART (by specific drug or overall).ConclusionsSHD is frequent and correlates with inflammation in HIV infected patients. Since SHD is also associated with falls and increased bone catabolism, it may be of interest to take into account not only the type of antiretroviral therapy but also the residual inflammation on HAART in order to assess functional and bone risks. This finding also suggests that vitamin D supplementation may be beneficial in these HIV-infected patients.

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Clinical Images: Digital acrometastasis revealing endometrial cancer relapseThe patient, a 68-year-old woman with a history of localized endometrial adenocarcinoma who had undergone hysterectomy followed by sequential chemotherapy and radiation therapy, was referred for evaluation of a painful mass on the second finger of the right hand (left). The mass had been insufficiently controlled by nonsteroidal antiinflammatory drug treatment and had rapidly increased in size during the preceding month. The patient had not experienced any trauma or fever, and acute gouty arthritis was suspected. Routine laboratory tests revealed negative blood cultures, moderate inflammatory syndrome (C-reactive protein 24 mg/liter), and normal levels of plasma uric acid. Plain radiography of the finger revealed osteoarthritis of the distal interphalangeal joint (DIJ) and a large soft tissue mass without calcification and no evidence of erosion of the phalanx (top right). Power Doppler ultrasonography of the finger (bottom right) (longitudinal view) showed a hypoechogenic solid hypervascular mass (blue Doppler signals) (arrows) in the soft tissue and surrounding the extensor tendon (asterisk), with no demonstrable involvement of the adjacent joints or bones. Histologic examination of a sample obtained by the ultrasound-guided biopsy revealed features of adenocarcinoma, compatible with digital acrometastasis (a rare site of carcinoma metastasis) of the endometrial cancer (1,2). The patient refused palliative amputation of the affected finger to relieve refractory cancer pain. A computed tomography scan showed multimetastatic dissemination to the liver, lung, and lumbar spine, leading to the patient's death 6 months after the presentation described here.