Van Den Bout-Van Den Beukel Carolien J P, Fievez Lydia, Michels Meta, Sweep Fred C G J, Hermus Ad R M M, Bosch Marjolein E W, Burger David M, Bravenboer Bert, Koopmans Peter P, Van Der Ven André J A M
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
AIDS Res Hum Retroviruses. 2008 Nov;24(11):1375-82. doi: 10.1089/aid.2008.0058.
Vitamin D regulates bone metabolism but has also immunoregulatory properties. In HIV-infected patients bone disorders are increasingly observed. Furthermore, low 1,25(OH)(2)D(3) levels have been associated with low CD4(+) counts, immunological hyperactivity, and AIDS progression rates. Few studies have examined the vitamin D status in HIV-infected patients. This study will specifically focus on the effects of antiretroviral agents on vitamin D status. Furthermore, the effect of vitamin D status on CD4 cell recovery after initiation of HAART will be evaluated. Among 252 included patients the prevalence of vitamin D deficiency (<35 nmol/liter from April to September and <25 nmol/liter from October to March) was 29%. Female sex, younger age, dark skin, and NNRTI treatment were significant risk factors in univariate analysis, although in multivariate analyses skin pigmentation remained the only independent risk factor. Median 25(OH)D(3) levels were significantly lower in white NNRTI-treated patients [54.5(27.9-73.8) nmol/liter] compared to white PI-treated patients [77.3 (46.6-100.0) nmol/liter, p = 0.007], while among nonwhites no difference was observed. Both PI- and NNRTI-treated patients had significantly higher blood PTH levels than patients without treatment. Moreover, NNRTI treatment puts patients at risk of elevated PTH levels (>6.5 pmol/liter). Linear regression analysis showed that vitamin D status did not affect CD4 cell recovery after initiation of HAART. In conclusion, 29% of the HIV-1-infected patients had vitamin D deficiency, with skin color as an independent risk factor. NNRTI treatment may add more risk for vitamin D deficiency. Both PI- and NNRTI-treated patients showed higher PTH levels and might therefore be at risk of bone problems. Evaluation of 25(OH)D(3) and PTH levels, especially in NNRTI-treated and dark skinned HIV-1-infected patients, is necessary to detect and treat vitamin D deficiency early.
维生素D调节骨代谢，但也具有免疫调节特性。在HIV感染患者中，骨疾病越来越常见。此外，1,25(OH)₂D₃水平低与CD4⁺细胞计数低、免疫功能亢进及艾滋病进展率相关。很少有研究检测HIV感染患者的维生素D状态。本研究将特别关注抗逆转录病毒药物对维生素D状态的影响。此外，还将评估维生素D状态对开始高效抗逆转录病毒治疗（HAART）后CD4细胞恢复的影响。在纳入的252例患者中，维生素D缺乏（4月至9月<35 nmol/升，10月至3月<25 nmol/升）的患病率为29%。在单因素分析中，女性、年轻、肤色深及接受非核苷类逆转录酶抑制剂（NNRTI）治疗是显著危险因素，尽管在多因素分析中，皮肤色素沉着仍是唯一的独立危险因素。与接受蛋白酶抑制剂（PI）治疗的白人患者[77.3（46.6 - 100.0）nmol/升，p = 0.007]相比，接受NNRTI治疗的白人患者的25(OH)D₃水平中位数显著更低[54.5（27.9 - 73.8）nmol/升]，而在非白人患者中未观察到差异。接受PI和NNRTI治疗的患者的血甲状旁腺激素（PTH）水平均显著高于未接受治疗的患者。此外，NNRTI治疗使患者有PTH水平升高（>6.5 pmol/升）的风险。线性回归分析显示，维生素D状态不影响开始HAART后CD4细胞的恢复。总之，29%的HIV - 1感染患者存在维生素D缺乏，肤色是独立危险因素。NNRTI治疗可能增加维生素D缺乏的风险。接受PI和NNRTI治疗的患者均表现出较高的PTH水平，因此可能有骨问题风险。检测25(OH)D₃和PTH水平，尤其是在接受NNRTI治疗和肤色深的HIV - 1感染患者中，对于早期发现和治疗维生素D缺乏很有必要。
