美国 HIV 感染者和未感染者中维生素 D 缺乏。
Vitamin D deficiency in HIV-infected and HIV-uninfected women in the United States.
机构信息
Department of Medicine, CORE Center, Cook County Hospital, Chicago, IL, USA.
出版信息
J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):197-204. doi: 10.1097/QAI.0b013e31821ae418.
BACKGROUND
Vitamin D deficiency is of increasing concern in HIV-infected persons because of its reported association with a number of negative health outcomes that are common in HIV. We undertook this study to determine the prevalence and predictors of vitamin D deficiency among a nationally representative cohort of middle-aged, ethnically diverse, HIV-infected and HIV-uninfected women enrolled in the Women's Interagency HIV Study (WIHS).
METHODS
Vitamin D testing was performed by Quest Diagnostics on frozen sera using the liquid chromatography/mass spectroscopy method. Vitamin D deficiency was defined as 25(OH)D ≤20 ng/mL. Comparisons of continuous and categorical characteristics among HIV-infected and HIV-uninfected women were made by Wilcoxon tests and Pearson χ tests, respectively.
RESULTS
One thousand seven hundred seventy-eight women (1268 HIV positive) were studied. Sixty-three percent had vitamin D deficiency (60% HIV positive vs. 72% HIV negative; P < 0.001). Multivariable predictors of vitamin D deficiency were being African American (adjusted odds ratio 3.02), Hispanic (adjusted odds ratio 1.40), body mass index (adjusted odds ratio 1.43), age (adjusted odds ratio 0.84), HIV positive (adjusted odds ratio 0.76), glomerular filtration rate <90·mL·min (adjusted odds ratio 0.94), and WIHS sites Los Angeles (adjusted odds ratio 0.66) and Chicago (adjusted odds ratio 0.63). In the HIV-positive women, multivariate predictors were undetectable HIV RNA (adjusted odds ratio 0.69), CD4 50-200 cells per cubic millimeter (adjusted odds ratio 1.60), CD4 <50 cells per cubic millimeter (adjusted odds ratio 1.94), and recent protease inhibitor use (adjusted odds ratio 0.67).
CONCLUSIONS
In this study of more than 1700 women in the United States, most women with or without HIV infection had low vitamin D levels and African American women had the highest rates of vitamin D deficiency. An understanding of the role that vitamin D deficiency plays in non-AIDS-related morbidities is planned for investigation in WIHS.
背景
由于维生素 D 缺乏与 HIV 感染者中许多常见的负面健康结果有关，因此人们越来越关注 HIV 感染者的维生素 D 缺乏问题。我们进行这项研究，旨在确定在全国代表性的中年、多种族、HIV 感染者和未感染者女性队列中，维生素 D 缺乏的患病率和预测因素，这些女性参加了妇女艾滋病研究机构间合作（Women's Interagency HIV Study，WIHS）。
方法
使用 Quest Diagnostics 的液相色谱/质谱法对冷冻血清进行维生素 D 检测。将 25(OH)D≤20ng/ml 定义为维生素 D 缺乏。通过 Wilcoxon 检验和 Pearson χ 检验分别比较 HIV 感染者和未感染者的连续和分类特征。
结果
共纳入 1778 名女性（1268 名 HIV 阳性）。63%的女性有维生素 D 缺乏（60%HIV 阳性与 72%HIV 阴性；P<0.001）。维生素 D 缺乏的多变量预测因素为非裔美国人（调整后的优势比 3.02）、西班牙裔（调整后的优势比 1.40）、体重指数（调整后的优势比 1.43）、年龄（调整后的优势比 0.84）、HIV 阳性（调整后的优势比 0.76）、肾小球滤过率<90·ml·min（调整后的优势比 0.94）以及 WIHS 地点洛杉矶（调整后的优势比 0.66）和芝加哥（调整后的优势比 0.63）。在 HIV 阳性女性中，多变量预测因素为无法检测到的 HIV RNA（调整后的优势比 0.69）、CD4 细胞 50-200 个/立方毫米（调整后的优势比 1.60）、CD4 细胞<50 个/立方毫米（调整后的优势比 1.94）和最近使用蛋白酶抑制剂（调整后的优势比 0.67）。
结论
在这项对美国 1700 多名女性的研究中，大多数 HIV 感染者和未感染者的维生素 D 水平较低，非裔美国女性的维生素 D 缺乏率最高。计划在 WIHS 中研究维生素 D 缺乏在非艾滋病相关发病率中的作用。
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