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91% Have Low Vitamin D Levels in UK Cohort, 34% Severely Deficient; Efavirenz use is associated with severe Vitamin D deficiency in a large, ethnically diverse, urban UK HIV cohort
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Reported by Jules Levin
5th IAS July 19-22 2009 Capetown
T Welz1, K Childs1, F Ibrahim2, M. Poulton1, F. Post1,2
1. Caldecot Clinic, King's College Hospital NHS Trust, London, UK
2. King's College London School of Medicine , London, UK
from Jules: cross-sectional study of 1077 patients in cohort 80% on HAART: 35% severely deficient vitamin D levels (<10 ug/ml), 73% deficient (<20 ug/ml), 91% suboptimal (<30 ug/ml) and only 9% had optimal levels which looks like the cutoff was 30 ug/ml but 50 ug/ml might be better. 24% of patients were on a PI and 54% on NNRTI. There could be confounders as this is a cohort cross-sectional look and they found EFV associated with low vitamin D levels but PIs were not associated. However, in the current JAIDS a study reported by Todd Brown & Grace McComsey finds equal bone loss -2.3% and -2.5% over 96 weeks whether patients were on EFV or Kaletra. Perhaps there are different mechanisms of action in the way PIs or NNRTIs result in bone loss in HIV+. I don't think it's only EFV but lots of ARTs and HIV itself are to blame for bone loss, although an interaction with the p450 system could make it worse for both NNRTIs and PIs and for certain nukes. I think lactic acidosis and mitochondrial toxicity also may cause bone loss related to HIV itself and to therapy. No matter how you cut this the subject is NOT receiving adequate discussion and research attention to characterize the questions, and for education, guidance and recommendations for doctors, care providers and patients.
References:
1.Holick MF. Vitamin D deficiency. N.Engl.J.Med. 2007 Jul 19;357(3):266-281;
2. Van Den Bout-Van Den Beukel,C.J et al. Vitamin deficiency among HIV type 1-infected individuals in the Netherlands: effects of antiretroviral therapy. AIDS Res.Hum.Retroviruses 2008 Nov 24(11):375-1382;
3.Rosenvinge MM et al. Unexpectedly high rates of vitamin D deficiency in an inner-city London HIV clinic. Oral abstract O15. 14th Annual BHIVA Conference, Dublin, 2008.
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