Login Register Cart 0
Generic placeholder image

Infectious Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

The Effect of Low Dose Oral Vitamin D on Bone Mineral Density Changes in HIV Patients: 36 Months Follow Up

Author(s): Jasreen Dhother, Shyamalie Bopitiya, Huda Taha and Satyajit Das*

Volume 20, Issue 5, 2020

Page: [651 - 658] Pages: 8

DOI: 10.2174/1871526519666190618160748

Price: $65

Abstract

Background: A high incidence of vitamin-D deficiency and abnormal bone mineral density (BMD) is reported among Human Immunodeficiency Virus (HIV) infected patients. The study highlighted the effect of oral low dose vitamin-D replacement in patients with a known vitamin- D deficiency on the levels of vitamin-D [25 (OH)D], parathyroid hormone (PTH) and Bone Mineral Density (BMD) of hip and spine.

Methods: Patients took a daily low dose of 800IU of vitamin-D. The following details were collected on all patients: demographics, CD-4 cell count, viral load, fracture risk factors, treatment history, corrected calcium, alkaline phosphatase (ALP), Parathyroid Hormone (PTH) (intact PTH), vitamin D 25(OH)D, inorganic phosphate and BMD of hip and spine at baseline, 12 and 36 months.

Results: Our Cohort consisted of 86 patients. Patient details included: mean age 42.8 (+/-7.7) years, 48 (55%) females 64, (74%) black African, CD-4 count 440.7 (+/-180.8) cells/dL, plasma VL 1.6 log (+/-2.3) copies/mL, duration of illness 80.9 (34.1) months, duration of exposure to antiretroviral 65.2 (+/-27.9) months. At baseline, no difference in BMD of hip or spine was observed, however, a higher PTH (0.001) in patients taking Tenofivir and a lower vitamin-D was noticed in patients taking Efavirenz.

After 36 months, patients on vitamin D replacement (n=44) had a significant increase in vitamin- D level (15.4 +/-10.4 vs 104.1+/-29.1 p=0.0001), lower PTH (6.3 +/-3.4 vs 4.4 +/-1.4 p=0.0001) ALP (108.9+/-78.8 vs 90.6+/-45.8 p=0.05) but no change in corrected calcium (2.13 +/-0.1 vs 2.16 +/-0.34 p=0.5) and BMD of spine (1.039+/-0.226 vs.1.027+/-0.211, p=0.77), and BMD of hip (1.020 +/- 0.205 vs. 1.039, p=0.61). In a multivariate logistic regression analysis that included all significant variables, vitamin-D replacement independently was associated with increase in vitamin- D level (OR 2.08, CI 1.03, 4.12, p=0.005), decrease in PTH level (OR 0.53, CI 0.35, 0.82, p=0.04), but not with change in corrected calcium, alkaline phosphatase, BMD of hip or spine.

Conclusion: After 36 months of follow up, the replacement of low dose once daily oral vitamin-D in the treatment experienced HIV infected patients with vitamin-D deficiency can increase vitamin- D level, reduce PTH level without any change in BMD of spine and hip.

Keywords: Vitamin D, HIV, antiretroviral therapy, parathyroid hormone, bone mineral density, fracture.

[1]
Bongiovanni, M.; Tincati, C. Bone diseases associated with human immunodeficiency virus infection: pathogenesis, risk factors and clinical management. Curr. Mol. Med., 2006, 6(4), 395-400.http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1566-5240&volume=6&issue=4&spage=395
[http://dx.doi.org/10.2174/156652406777435435] [PMID: 16900662]
[2]
P, M Vitamin D deficiency in HIV infection: Not only a bone disorder. BioMed Research International, 2015((Mansueto P.; Seidita A.; Vitale G.) Department of Internal Medicine and Biomedicine, University of Palermo, Palermo, Italy)., 2015.http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L604363139
[3]
Kruger, M.J.; Nell, T.A. Bone mineral density in people living with HIV: a narrative review of the literature. AIDS Res. Ther., 2017, 14(1), 35.
[http://dx.doi.org/10.1186/s12981-017-0162-y] [PMID: 28747190]
[4]
Lake, J.E. Vitamin D in HIV-Infected Patients. Curr. HIV/AIDS Rep., 2011, 8(3), 133-141.www.ncbi.nlm.nih.gov/pmc/articles/PMC3666828/
[5]
Jiménez-Sousa, M.Á.; Martínez, I.; Medrano, L.M.; Fernández-Rodríguez, A.; Resino, S. Vitamin D in human immunodeficiency vi-rus infection: Influence on immunity and disease. Front. Immunol., 2018, 9(3), 458.
[http://dx.doi.org/10.3389/fimmu.2018.00458] [PMID: 29593721]
[6]
Visser, M.E. 2017, Micronutrient supplementation in adults with HIV infection. Cochrane Database Syst. Rev., 2017, (5)CD003650
[http://dx.doi.org/10.1002/14651858.CD003650.pub4]
[7]
Bischoff-Ferrari, H.A.; Willett, W.C.; Wong, J.B.; Giovannucci, E.; Dietrich, T.; Dawson-Hughes, B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA, 2005, 293(18), 2257-2264.
[http://dx.doi.org/10.1001/jama.293.18.2257] [PMID: 15886381]
[8]
Bischoff, H.A.; Stähelin, H.B.; Dick, W.; Akos, R.; Knecht, M.; Salis, C.; Nebiker, M.; Theiler, R.; Pfeifer, M.; Begerow, B.; Lew, R.A.; Conzelmann, M. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J. Bone Miner. Res., 2003, 18(2), 343-351.
[http://dx.doi.org/10.1359/jbmr.2003.18.2.343] [PMID: 12568412]
[9]
Murad, M.H.; Elamin, K.B.; Abu Elnour, N.O.; Elamin, M.B.; Alkatib, A.A.; Fatourechi, M.M.; Almandoz, J.P.; Mullan, R.J.; Lane, M.A.; Liu, H.; Erwin, P.J.; Hensrud, D.D.; Montori, V.M. Clinical review: The effect of vitamin D on falls: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab., 2011, 96(10), 2997-3006.
[http://dx.doi.org/10.1210/jc.2011-1193] [PMID: 21795448]
[10]
Vitamin D with or without calcium supplementation for prevention of cancer and fractures: An updated meta-analysis for the U.S. pre-ventive services task force. Ann. Intern. Med., 2011, 155(12), 827-838.www.embase.com/search/results?subaction=viewrecord&from=export&id=L363112952
[11]
Focà, E.; Motta, D.; Borderi, M.; Gotti, D.; Albini, L.; Calabresi, A.; Izzo, I.; Bellagamba, R.; Narciso, P.; Sighinolfi, L.; Clò, A.; Gibellini, D.; Quiros-Roldan, E.; Brianese, N.; Cesana, B.M.; Re, M.C.; Torti, C. Prospective evaluation of bone markers, parathormone and 1,25-(OH)2 vitamin D in HIV-positive patients after the initiation of tenofovir/emtricitabine with atazanavir/ritonavir or efavirenz. BMC Infect. Dis., 2012, 12, 38.
[http://dx.doi.org/10.1186/1471-2334-12-38] [PMID: 22333484]
[12]
Das, S.; Bopitya, S.; Chowdhury, A.R.; Das, A.; Taha, H. Effect of Low Dose Oral Vitamin-D and Calcium Replacement in HIV Patients. Recent Pat Antiinfect Drug Discov, 2016, 11(1), 59-67.http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1574-891X&volume=11&issue=1&spage=59
[http://dx.doi.org/10.2174/1574891X11666160201122236] [PMID: 26844688]
[13]
Benguella, L.; Arbault, A.; Fillion, A.; Blot, M.; Piroth, C.; Denimal, D.; Duvillard, L.; Ornetti, P.; Chavanet, P.; Maillefert, J.F.; Piroth, L. Vitamin D supplementation, bone turnover, and inflammation in HIV-infected patients. Med. Mal. Infect., 2018, 48(7), 449-456.
[http://dx.doi.org/10.1016/j.medmal.2018.02.011] [PMID: 29661598]
[14]
FRAX®, 2012. FRAX ® Fracture Risk Assessment Tool.. Centre for Metabolic Bone Diseases, University of Sheffield, UK, 2012.
[15]
Puthanakit, T.; Wittawatmongkol, O.; Poomlek, V.; Sudjaritruk, T.; Brukesawan, C.; Bunupuradah, T.; Sricharoenchai, S.; Chuanjaroen, T.; Prasitsuebsai, W.; Chokephaibulkit, K. Effect of calcium and vitamin D supplementation on bone mineral accrual among HIV-infected Thai adolescents with low bone mineral density. J. Virus Erad., 2018, 4(1), 6-11.https://www.frontiersin.org/article/10.3389/fendo.2018.00500/full
[PMID: 29568546]
[16]
Arpadi, S.M.; McMahon, D.; Abrams, E.J.; Bamji, M.; Purswani, M.; Engelson, E.S.; Horlick, M.; Shane, E. Effect of bimonthly supplementation with oral cholecalciferol on serum 25- hydroxyvitamin D concentrations in HIV-infected children and adolescents. Pediatrics, 2009, 123(1), e121-e126.http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2008-0176
[http://dx.doi.org/10.1542/peds.2008-0176] [PMID: 19117833]
[17]
McComsey, G.A.; Kendall, M.A.; Tebas, P.; Swindells, S.; Hogg, E.; Alston-Smith, B.; Suckow, C.; Gopalakrishnan, G.; Benson, C.; Wohl, D.A. Alendronate with calcium and vitamin D supplementation is safe and effective for the treatment of decreased bone mineral density in HIV. AIDS, 2007, 21(18), 2473-2482.
[http://dx.doi.org/10.1097/QAD.0b013e3282ef961d] [PMID: 18025884]
[18]
Noe, S.; Moeckel, C.I.; Schwerdtfeger, C.; Oldenbuettel, C.; Jaeger, H.; Wolf, E.; Spinner, C.D. Monthly or weekly supplementation with cholecalciferol 20,000 IU in people living with HIV: Results from a nested cohort study. Interdiscip. Perspect. Infect. Dis., 2018, 20187502127
[http://dx.doi.org/10.1155/2018/7502127] [PMID: 30245713]
[19]
National Osteoporosis Society et al. Vitamin D and Bone Health : A Practical Clinical Guideline for Patient Man-agement; National Osteoporosis Society, 2013, pp. 1-25.
[20]
Havens, P.L. 2018.Tenofovir disoproxil fumarate appears to disrupt the relationship of vitamin D and parathy-roid hormone., https://www.intmedpress.com/journals/avt/abstract.cfm?id=3269&pid=48
[21]
Cervero, M.; Torres, R.; Agud, J.L.; Alcázar, V.; Jusdado, J.J.; García-Lacalle, C.; Moreno, S. Prevalence of and risk factors for low bone mineral density in Spanish treated HIV-infected patients. PLoS One, 2018, 13(4)e0196201
[http://dx.doi.org/10.1371/journal.pone.0196201] [PMID: 29709013]
[22]
Vescini, F.; Cozzi-Lepri, A.; Borderi, M.; Re, M.C.; Maggiolo, F.; De Luca, A.; Cassola, G.; Vullo, V.; Carosi, G.; Antinori, A.; Tozzi, V.; Monforte, A.D. Icona Foundation Study Group. Prevalence of hypovitaminosis D and factors associated with vitamin D deficiency and morbidity among HIV-infected patients enrolled in a large Italian cohort. J. Acquir. Immune Defic. Syndr., 2011, 58(2), 163-172.
[http://dx.doi.org/10.1097/QAI.0b013e31822e57e9] [PMID: 21826011]
[23]
Wohl, D.A.; Orkin, C.; Doroana, M.; Pilotto, J.H.; Sungkanuparph, S.; Yeni, P.; Vanveggel, S.; Deckx, H.; Boven, K. Change in vitamin D levels and risk of severe vitamin D deficiency over 48 weeks among HIV-1-infected, treatment-naive adults receiving rilpivirine or efavirenz in a Phase III trial (ECHO). Antivir. Ther. (Lond.), 2014, 19(2), 191-200.
[http://dx.doi.org/10.3851/IMP2721] [PMID: 24430534]

Rights & Permissions Print Cite
Article Metrics
8
© 2025 Bentham Science Publishers | Privacy Policy