{"id":585,"date":"2008-08-30T18:05:35","date_gmt":"2008-08-30T17:05:35","guid":{"rendered":"http:\/\/localhost\/new\/htb\/?p=585"},"modified":"2013-08-27T16:05:10","modified_gmt":"2013-08-27T16:05:10","slug":"bone-problems-raised-in-several-uk-studies","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/585","title":{"rendered":"Bone problems raised in several UK studies"},"content":{"rendered":"

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

Several small studies looked at markers of bone metabolism in patients on HAART.<\/strong><\/p>\n

M Rosenvinge and colleagues from St Georges reported an unexpectedly high rate of vitamin D deficiency in a retrospective case note review of 132 consecutive patients attending their out-patients clinic from November 2007. [1]<\/p>\n

They reported 58% patients (76\/132) had 25-hydroxycholecalciferol (25(OH)D) deficiency including 8% (11 patients) who were severely deficient (<25nmol\/L). A further 27% had borderline deficiency (50-75nmol\/L) and only 16% of patients had optimum levels.<\/p>\n

Multivariate analysis identified associations with black race (OR 0.14 95%CI 0.02-0.88, white vs black), younger age (OR 0.87, 95%CI 0.78-0.97, for every increase in age by one year) and higher random blood glucose (OR 3.21 95%CI 1.32-7.8 for every increase by 1mmol\/L).<\/p>\n

No association was found with diagnosis date, CDC stage, use\/duration of tenofovir\/HAART, weight, kidney\/bone profile or parathyroid hormone levels.<\/p>\n

Klassen and colleagues from Imperial College reported a case study of severe vitamin D deficiency in a 67 year old Somalian patient who had presented with bone pain, hypophosphatemia (0.64 mmol\/L) and raised alkaline phosphatase (>500U\/L) while on tenofovir-based HAART. [2]<\/p>\n

Vitamin D levels were severely deficient (<15 nmol\/L) and she had secondary hyperparathyroidism. Pelvic x-ray was normal.<\/p>\n

Vitamin D supplement (dosed 15\u00b5g\/day) rapidly improved clinical symptoms and normalised phosphate and alkaline phosphatase levels, and Truvada\/efavirenz was maintained.<\/p>\n

A second poster from this group looked at risk factors for low vitamin D in a group of 79 patients who had been assessed for 25(OH)D levels over a 2-year period. [3]<\/p>\n

Mean age of the group was 41 (range 17-72), 70% were on HAART, median CD4 was 380 (range 0-930. 53% were women, 49% were African (33% Caucasian),<\/p>\n

Median vitamin D levels were 31 nmol\/L (range <15-145). 23% patients had severe deficiency (<25 nmol\/L) and 70% has less than optimum levels (25-74 nmol\/L). Higher levels were associated with Caucasian origin (P=0.025), current use of HAART (p=0.010) and duration of HAART (p=0.026). CD4 count, season, gender, PI or tenofovir use had no significant association (p>0.064 for all).<\/p>\n

S Hill and colleagues from St Mary’s and Hillingdon Hospitals presented an analysis of markers of bone metabolism and the clinical impact in a retrospective review of 205 patients (45% women, 55% black) seen in their cohort during 2007. [4]<\/p>\n

From a mean of almost four calcium tests during the year, 42% patients had >1 low calcium level, 23% had >1 low phosphate and 20% had >1 high phosphate.<\/p>\n

Low calcium and phosphate levels were more common in patients on HAART and were seen in 47% vs 32% (p=0.06), and 30% vs 5% (p<0.0001) patients, but were not related to tenofovir use. Low vitamin D levels were more common in women than men (8% vs 2%), all of whom were non-Caucasian.<\/p>\n

References:<\/p>\n

All references are to the Programme and Abstracts of the 14th Annual BHIVA Conference, Dublin, 2008, published as Supplement to HIV Medicine, Volume 9.<\/p>\n

    \n
  1. Rosenvinge MM et al. Unexpectedly high rates of vitamin D deficiency in an inner-city London HIV clinic. Oral abstract O15.<\/li>\n
  2. Klassen K et al. Vitamin D deficiency presenting with hypophosphatemia, bone pain and a raised alkaline phosphatase in a patient on tenofovir. Poster P83.<\/li>\n
  3. Klassen K et al. Risk factors for hypovitaminosis D in HIV-positive individuals. Poster P95A.<\/li>\n
  4. Hill S et al. How common are abnormalities of serum calcium, phosphate and vitamin D in an HIV-positive cohort and what is their clinical significance. Poster 96.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Several small studies looked at markers of bone metabolism in patients on HAART. M Rosenvinge and colleagues from St Georges reported an unexpectedly high rate of vitamin D deficiency in a retrospective case note review of …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8],"tags":[50],"class_list":["post-585","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-side-effects","tag-bhiva-14th-2008"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/585","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=585"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/585\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=585"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=585"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=585"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}