{"id":1688,"date":"2009-06-08T18:14:13","date_gmt":"2009-06-08T18:14:13","guid":{"rendered":"http:\/\/localhost.localdomain\/wpmu\/htb\/?p=1688"},"modified":"2013-08-16T13:32:33","modified_gmt":"2013-08-16T13:32:33","slug":"vitamin-d-deficiency-supplementation-and-tenofovir","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/1688","title":{"rendered":"Vitamin D deficiency, supplementation and tenofovir"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

T Welz and colleague from Kings College Hospital presented results from a cross-sectional study of serum 25(OH)D levels in over 1000 HIV-positive adults. Median age was 40 years (IQR 35, 46), 60% men, 35% white, 58% black, CD4 452 cells\/mm3 (IQR 324, 613).<\/strong> [1]<\/p>\n

Just over 90% patients were defined as sub-optimal (<30 lg\/L), 73% as defificient (<20 lg\/L), 34% as severely defificient (<10 lg\/L) and 6% with undetectable levels. Although median serum 25(OH)D was slightly higher in the summer than winter (14.2 versus 11.2 lg\/L; p<0.001), this did not significantly improve the proportion of patients with less deficiency.<\/p>\n

Factors associated with lower serum 25(OH)D were black race (p<0.001), low CD4 nadir (P<0.002) and efavirenz use (p<0.004). Tenofovir use was associated with a higher level (p=0.001). However, patients with low 25(OH)D on tenofovir were twice as likely to have an elevated ALP than those on abacavir (OR=2.4 [CI 1.5, 3.9]; and four times as likely compared to other NRTIs (OR=4.6 [CI 1.6, 13.3].<\/p>\n

The presentation concluded that their results supported routine testing as calcium and ALP did not detect low 25(OH)D levels. Testing is inexpensive (~\u00a320) and vitamin D supplementation is inexpensive, even when higher doses are needed.<\/p>\n

The benefits of vitamin D and calcium supplements were reported by Childs and colleagues from Kings College London, in 32 HIV-positive men with suboptimal levels of 25(OH)D (<30 ng\/mL). Daily supplement vitamin D3 (VD3) were prescribed dosed by baseline levels: 2800 IU [25(OH)D < 10]; 1800 IU [25(OH)D = 10\u009620]; 800 IU [25(OH)D = 20\u009630], all with additional 1g calcium citrate daily.<\/p>\n

Follow-up tests were performed on 20 subjects: 16 on tenofovir-containing HAART; 4 on non-tenofovir-containing HAART. There was a strong association between suboptimal 25(OH)D levels and parathyroid abnormalities. Among the 32 subjects with suboptimal 25(OH)D, mean PTH was 80 \u00b1 32 pg\/mL in those on tenofovir and 56 \u00b1 19 pg\/mL in those on non-tenofovir HAART (p=0.02). Among subjects with suboptimal 25(OH)D, 37% (10\/27) on tenofovir had PTH >ULN, indicating secondary hyperparathyroidism (SHPT), while none of the 10 subjects with low vitamin D on non- tenofovir HAART had SHPT (p=0.03).<\/p>\n

VD3 supplementation increased 25(OH)D by 9.8 \u00b1 5.6 ng\/mL (P < 0.001) and PTH fell 18.9 \u00b1 31.7 pg\/mL (p=0.002). Parathyroid hormone (PTH) rose 4.4 pg\/mL among subjects in the bottom third of baseline PTH values. In contrast, it fell 5.3 pg\/mL among subjects in the middle third, and fell 44.7 pg\/mL among subjects in the top third (p=0.001, ANOVA). All subjects in the upper third were on tenofovir and all experienced a PTH decrease.<\/p>\n

The researchers concluded that VD3\/calcium supplements increased serum 25(OH)D and decreased PTH and are a safe and effective treatment for HAART-associated hyperparathyroidism.<\/p>\n

References:<\/p>\n

    \n
  1. Welz T et al. Risk factors for vitamin D defificiency in an ethnically diverse urban HIV cohort: Which antiretrovirals are implicated? 15th Annual Conference of the British HIV Association (BHIVA), 1-3 April 2009, Liverpool.\u00a0Oral abstract O6.<\/li>\n
  2. Childs K et al. Vitamin D and calcium supplements reverse the secondary hyperparathyroidism that commonly occurs in HIV patients on TDF-containing HAART. 15th Annual Conference of the British HIV Association (BHIVA), 1-3 April 2009, Liverpool.\u00a0Poster abstract P89.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base T Welz and colleague from Kings College Hospital presented results from a cross-sectional study of serum 25(OH)D levels in over 1000 HIV-positive adults. Median age was 40 years (IQR 35, 46), 60% men, 35% white, 58% …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[51],"class_list":["post-1688","post","type-post","status-publish","format-standard","hentry","category-conference-reports","tag-bhiva-15th-2009"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/1688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=1688"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/1688\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=1688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=1688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=1688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}