Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
AIDS Res Ther. 2010 Nov 23;7:40. doi: 10.1186/1742-6405-7-40.
Vitamin D is an important determinant of bone health and also plays a major role in the regulation of the immune system. Interestingly, vitamin D status before the start of highly active antiretroviral therapy (HAART) has been recently associated with HIV disease progression and overall mortality in HIV-positive pregnant women. We prospectively studied vitamin D status in HIV individuals on HAART in Belgium.We selected samples from HIV-positive adults starting HAART with a pre-HAART CD4 T-cell count >100 cells/mm3 followed up for at least 12 months without a treatment change. We compared 25-hydroxyvitamin D plasma [25-(OH)D] concentration in paired samples before and after 12 months of HAART. 25-(OH)D levels are presented using two different cut-offs: <20 ng/ml and <30 ng/ml.
Vitamin D deficiency was common before HAART, the frequency of plasma 25-(OH)D concentrations below 20 ng/ml and 30 below ng/ml was 43.7% and 70.1% respectively. After 12 months on HAART, the frequency increased to 47.1% and 81.6%.HAART for 12 months was associated with a significant decrease of plasma 25-(OH)D concentration (p = 0.001). Decreasing plasma 25-(OH)D concentration on HAART was associated in the multivariate model with NNRTI-based regimen (p = 0.001) and lower body weight (p = 0.008). Plasma 25-(OH)D concentrations decreased significantly in both nevirapine and efavirenz-containing regimens but not in PI-treated patients.
Vitamin D deficiency is frequent in HIV-positive individuals and NNRTI therapy further decreases 25-(OH)D concentrations. Consequently, vitamin D status need to be checked regularly in all HIV-infected patients and vitamin D supplementation should be given when needed.
维生素 D 是骨骼健康的重要决定因素，在免疫系统调节中也起着主要作用。有趣的是，在开始高效抗逆转录病毒治疗（HAART）之前的维生素 D 状态最近与 HIV 阳性孕妇的 HIV 疾病进展和总死亡率相关。我们前瞻性地研究了比利时接受 HAART 的 HIV 个体的维生素 D 状态。我们选择了开始 HAART 前 CD4 T 细胞计数 >100 个细胞/mm3 的 HIV 阳性成年人的样本，并进行了至少 12 个月的随访，没有治疗改变。我们比较了 HAART 前和 12 个月后的配对样本中 25-羟维生素 D 血浆[25-(OH)D]浓度。25-(OH)D 水平使用两个不同的截止值表示：<20ng/ml 和 <30ng/ml。
HAART 前维生素 D 缺乏很常见，血浆 25-(OH)D 浓度低于 20ng/ml 和低于 30ng/ml 的频率分别为 43.7%和 70.1%。在接受 HAART 治疗 12 个月后，频率增加到 47.1%和 81.6%。HAART 治疗 12 个月与血浆 25-(OH)D 浓度的显著下降相关（p = 0.001）。在多变量模型中，HAART 期间血浆 25-(OH)D 浓度的下降与基于 NNRTI 的方案相关（p = 0.001），与体重减轻相关（p = 0.008）。在包含奈韦拉平的方案和包含依非韦伦的方案中，血浆 25-(OH)D 浓度显著下降，但在使用 PI 的患者中则没有。
维生素 D 缺乏在 HIV 阳性个体中很常见，NNRTI 治疗进一步降低 25-(OH)D 浓度。因此，所有 HIV 感染患者都需要定期检查维生素 D 状态，需要时应给予维生素 D 补充。
