Vitamin D deficiency and its association with low bone mineral density, HIV-related factors, hospitalization, and death in a predominantly black HIV-infected cohort

Abstract

Background: Low bone mineral density (BMD) is common among patients infected with human immunodeficiency virus (HIV) and present in higher rates in black subjects. This study assessed vitamin D levels in HIV cases versus noninfected matched controls to determine if deficiency was associated with BMD and HIV clinical outcomes.

Methods: In total, 271 military beneficiaries with HIV underwent dual energy x-ray absorptiometry (DEXA) screening in 2001-2. Serum 25OH-vitamin D levels were determined using stored serum from the time of DEXA and 6-18 months prior. Two non-HIV-infected controls for each active duty case (n = 205) were matched on age, sex, race, zip code, and season using the Department of Defense Serum Repository (DoDSR). Vitamin D levels <20 ng/mL were considered deficient. HIV-related factors and clinical outcomes were assessed using data collected in the DoD HIV Natural History study.

Results: In total, 165 of 205 (80.5%) active duty HIV cases had 2 matched controls available. HIV cases had greater odds of for vitamin D deficiency (VDD) compared with controls (demographics adjusted paired data odds ratio [OR], 1.46, 95% confidence interval [CI], .87-2.45), but this was not statistically significant. Blacks were disproportionately deficient (P <.001) but not relative to HIV status or BMD. Low BMD was associated with typical risk factors (low body mass index and exercise levels, alcohol use); given limited available data the relationship between tenofovir exposure and VDD or low BMD could not be determined. Analysis of HIV-specific factors and outcomes such as exposure to antiretrovirals, HIV progression, hospitalizations, and death revealed no significant associations with vitamin D levels.

Conclusions: VDD was highly prevalent in black HIV- infected persons but did not explain the observed racial disparity in BMD. Vitamin D deficiency was not more common among HIV- infected persons, nor did it seem associated with HIV- related factors/clinical outcomes.

Figure 1.

Geographic distribution of human immunodeficiency virus (HIV)–infected study participants in the 48 contiguous states* with summaries of season-averaged serum vitamin D levels by intervals of latitude; restricted to participants with 2 vitamin D measures with season-averaged serum levels summarized by – size No.: median [IQR], n = 266: 14.8 [9.1–22.4]. *Among the 270 HIV-infected subjects, 3 did not reside in the 48 contiguous states; 3 subjects were stationed in Germany, Panama, and Puerto Rico. Abbreviation: IQR, interquartile range.

Figure 2.

Active duty HIV-infected case versus matched non-HIV infected control season-averaged vitamin D levels within race categories. Race groups differ qualitatively in association measured by paired-data odds ratios (ORs); given this as well as only 59 case-control matched pairs with discordant vitamin D status contribute to an overall OR, there is inadequate precision to rule out “no association” (OR, 1.46; 95% confidence interval, .87–2.45). Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus.