Vitamin D, bone, and HIV infection

Abstract

Vitamin D deficiency has been associated with increased risk for falls and fractures, diabetes and obesity, cardiovascular disease, some malignancies, and tuberculosis. Observational data have suggested benefit of higher vitamin D levels in many of these settings. However, data from randomized trials supporting the benefit of vitamin D supplementation are generally lacking, apart from data showing benefit in preventing falls and fractures in the elderly. HIV-infected persons have a high prevalence of vitamin D deficiency and insufficiency, and some antiretroviral drugs are known to interfere with vitamin D metabolism. However, as in the general population, there are currently few data from clinical trials to identify benefits of vitamin D screening and supplementation in the HIV-infected population. A rational approach is to screen at-risk patients (eg, those aged 50 years and older and those with osteoporosis, prior fracture, or high risk for falls); supplementation may be considered in specific subgroups of patients. This article summarizes a presentation by Michael Yin, MD, MS, at the IAS-USA live Improving the Management of HIV Disease continuing medical education program held in New York, New York, in October 2012.

Figure

Progression to AIDS (top), death (middle), and non-AIDS-related events (bottom) according to 25-hydroxyvitamin D tertile (lowest, _≤12 ng/mL; middle, 12.1-20 ng/mL; highest, > 20 ng/mL) in EuroSIDA analysis. Adapted from Viard et al.¹³