Severe hypovitaminosis D correlates with increased inflammatory markers in HIV infected patients

Abstract

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.

Risk factors associated with hypovitaminosis D in HIV/aids-infected adults

“…The prevalence of hypovitaminosis D was 24% and that of vitamin D deficiency was 1.6%, a result that was considered lower than in other studies of HIV-infected patients (12,19,25,26,29). Although prevalence was not high, it should be emphasized that Maceió is a city located at a low latitude, with high UV index (30), and high sunlight incidence all year long.…”

“…In this study, there was no association between alcohol intake and/or smoking with hypovitaminosis D. As for smoking, some studies with HIV carriers (19,25,26) showed a significant association with hypovitaminosis D, while other did not (12,29).…”

“…Although the adequate levels of vitamin D are debatable, in the presente study, values of 20(OH)D greater than 30 ng/mL were considered sufficient, because they presented better correlations with parameters of evaluation of the bone metabolism, such as calcium absorption, bone mineral density, and PTH levels (11). Besides this is the cutoff value adopted by several studies in HIV-infected patients (12,19,25,26).…”

Vitamin D Levels and Markers of Inflammation and Metabolism in HIV-Infected Individuals on Suppressive Antiretroviral Therapy

“…33 The association with 25(OH)D and TNF-a has not been reported from other studies of HIV-infected cohorts; however, in a randomized study of HIV-uninfected adults with congestive heart failure, TNF-a was stable over 9 months in the vitamin D repletion group but increased by 12% in the placebo group ( p = 0.017) suggesting a protective benefit in the inflammatory milieu of heart failure. 34 While at least one cross-sectional study has shown no association between low 25(OH)D levels and systemic inflammation, 22 several other cross-sectional studies have shown associations with IL-6 and hs-CRP [11][12][13] as well as with soluble TNF receptor 1 (sTNFR1), 35 soluble TNF receptor 2 (sTNFR2), and resistin. 13 These studies have included adults both on and off ART and most did not require virologic suppression for study inclusion, making direct comparisons with our cohort difficult.…”

“…10 Vitamin D levels may also have important implications for inflammation in patients with HIV infection. An emerging body of data in this population suggests associations between low vitamin D levels and elevated markers of inflammation including interleukin-6 (IL-6) and highsensitivity C-reactive protein (hs-CRP), [11][12][13] and in a random sample of 1,985 HIV-infected individuals in Europe, higher vitamin D levels were independently associated with a lower risk of mortality and AIDS events after adjusting for ART use, CD4…”