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15th Annual Conference of the British HIV Association1-3 April 2009, Liverpool, UK |
RISK FACTORS FOR VITAMIN D DEFICIENCY IN AN ETHNICALLY DIVERSE URBAN HIV COHORT: WHICH ANTIRETROVIRALS ARE IMPLICATED?
HIV Med 2009 Apr 1-3; 10(Suppl. 1):6 (abstract no. O6)
T Welz1, K Childs1, F Ibrahim2, M Poulton1 and F Post2
1King’s College Hospital, London, UK, 2King’s College London, UK
BACKGROUND: Several studies have shown high rates of Vitamin D insufficiency among HIV patients and suggest that specific antiretrovirals may affect serum 25(OH)D [circulating vitamin D] levels. Optimal vitamin D status is associated with beneficial health outcomes including reduced fracture risk, cardiovascular morbidity and enhanced innate immunity.
METHODS: Cross sectional study of 1063 adult HIV outpatients in South London. Risk factors for low 25(OH)D and raised ALP were examined using multivariable linear regression.
RESULTS: Median age was 40 years (35, 46), 59.4% men, 35% white, 58% black, CD4 452 cells/mm3 (324, 613). Median serum 25(OH)D was 13.3 µg/L (8.2, 20.8). 91.2% had 25(OH)D levels <30 µg/L (suboptimal), 72.9% had 25(OH)D <20 µg/L (deficient), 34.2% <10 µg/L (severely deficient) and 6.4% had undetectable 25(OH)D levels. 25(OH)D levels were higher in the summer than winter (14.2 versus 11.2 µg/L; P<0.001), but the proportion attaining optimal 25(OH)D was not significantly different. Factors associated with lower serum 25(OH)D were black race (P<0.001), low CD4 nadir (0.002) and Efavirenz (EFZ) use (0.004). Tenofovir (TDF) use was associated with a higher 25(OH)D level (P=0.001). Factors associated with increased ALP (with normal AST) were increased duration of HIV (P=0.01), TDF use (P=0.03) and EFZ use (P=0.004). Serum calcium and CD4 count were inversely associated with ALP level. Patients with low 25(OH)D on TDF were twice as likely to have an ALP >ULN than those on ABC (OR=2.4 [CI 1.5, 3.9]; P=0.001) and 4 times as likely compared to other NRTIs (OR=4.6 [CI 1.6, 13.3] P=0.002).
CONCLUSIONS: Hypovitaminosis D is almost universal in this cohort. EFZ use was associated with a lower 25(OH)D and TDF with a higher 25(OH)D level, although both drugs were independently associated with ALP elevations. Further studies are required to define the potential mechanisms and clinical implications of this interaction between ART, Vitamin D and bone.
2009-04-01
O6
Copyright © 2009 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD