Brown Todd T, McComsey Grace A
Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, MD, USA.
Antivir Ther. 2010;15(3):425-9. doi: 10.3851/IMP1502.
We aimed to determine whether antiretroviral therapy (ART) initiation with efavirenz (EFV) is associated with decreases in 25-hydroxyvitamin D (25[OH]D) compared with non-EFV regimens.
25(OH)D was measured from stored plasma samples in 87 ART-naive HIV-positive patients prior to ART initiation with EFV-containing (n=51) or non-EFV-containing (89% with protease inhibitors; n=36) regimens from a single clinic in Cleveland (OH, USA). A repeat measurement was made 6-12 months after ART initiation. The change in 25(OH)D after ART initiation and the prevalence of patients with hypovitaminosis D (< or = 37.5 nmol/l [15 ng/ml]) after ART initiation was compared in those who initiated ART with and without EFV using multivariable linear and modified Poisson regression, respectively.
Prior to ART initiation, the median (interquartile range [IQR]) 25(OH)D concentration was 52.7 nmol/l (IQR 32.2-72.1), with 33% prevalence of hypovitaminosis D. After 6-12 months of ART, 25(OH)D decreased by a mean +/-se of -12.7 +/-3.7 nmol/l in the EFV group relative to the non-EFV group (P=0.001) after adjustment for baseline 25(OH)D concentration, race and season (non-summer versus summer) at the visit 6-12 months after ART initiation. Similarly, after multivariable adjustment, the risk of hypovitaminosis D after ART initiation was significantly higher in the EFV group compared with the non-EFV group (prevalence ratio 1.8 [95% confidence interval 1.2-2.8]; P=0.007).
ART initiation with EFV is associated with significant decreases in 25(OH)D and an increased risk of hypovitaminosis D compared with non-EFV regimens.
我们旨在确定与非依非韦伦（EFV）方案相比，开始使用依非韦伦（EFV）进行抗逆转录病毒治疗（ART）是否与25-羟基维生素D（25[OH]D）水平降低有关。
从美国俄亥俄州克利夫兰市一家诊所的87例初治HIV阳性患者的储存血浆样本中测量25(OH)D水平，这些患者开始接受含EFV方案（n = 51）或不含EFV方案（89%使用蛋白酶抑制剂；n = 36）的ART治疗。在ART开始后6 - 12个月进行重复测量。分别使用多变量线性回归和修正泊松回归，比较开始ART治疗时使用和未使用EFV的患者在ART开始后25(OH)D的变化以及ART开始后维生素D缺乏症（<或= 37.5 nmol/l [15 ng/ml]）患者的患病率。
在ART开始前，25(OH)D浓度中位数（四分位间距[IQR]）为52.7 nmol/l（IQR 32.2 - 72.1），维生素D缺乏症患病率为33%。在ART开始6 - 12个月后，在对ART开始后6 - 12个月就诊时的基线25(OH)D浓度、种族和季节（非夏季与夏季）进行调整后，EFV组的25(OH)D相对于非EFV组平均降低了 - 12.7 +/- 3.7 nmol/l（P = 0.001）。同样，经过多变量调整后，与非EFV组相比，EFV组在ART开始后维生素D缺乏症的风险显著更高（患病率比值1.8 [95%置信区间1.2 - 2.8]；P = 0.007）。
与非EFV方案相比，开始使用EFV进行ART治疗与25(OH)D显著降低以及维生素D缺乏症风险增加有关。
