AIDS. 2012 Jan 28;26(3):253-62. doi: 10.1097/QAD.0b013e32834f324b.
In the era of combination antiretroviral therapy (cART), vitamin D deficiency, low bone mineral density (BMD) and fractures have emerged as subjects of concern in HIV-positive patients. Testing for vitamin D deficiency has been widely adopted in clinical practice even though the benefits of vitamin D supplementation in this population remain uncertain. The objective of this review was to evaluate the evidence for such a strategy.
Systematic review of the literature on vitamin D deficiency in HIV infection, the effects of cART on vitamin D status, and the effects of vitamin D deficiency and cART on parathyroid hormone (PTH), bone turnover, BMD and the incidence of fractures in HIV-positive patients.
PubMed was used to identify relevant articles up to September 2011.
Vitamin D deficiency, secondary hyperparathyroidism and low BMD are common in HIV-positive patients. Efavirenz is associated with a reduction in 25-hydroxy vitamin D levels, tenofovir with secondary hyperparathyroidism, and cART with increased bone turnover and low BMD. The clinical significance of low BMD, however, remains unclear, especially in younger patients. Although the incidence of fractures may be increased in HIV-positive patients, the contribution of low BMD and vitamin D deficiency to these fractures is uncertain. Limited data on vitamin D supplementation in HIV-positive patients have shown transient, beneficial effects on PTH, but no effects on BMD.
The benefits of vitamin D supplementation in this population need to be demonstrated before widespread 'test and treat' policies can be recommended as part of routine clinical practice.
在联合抗逆转录病毒治疗（cART）时代，维生素 D 缺乏、低骨密度（BMD）和骨折已成为 HIV 阳性患者关注的问题。尽管维生素 D 补充对该人群的益处仍不确定，但检测维生素 D 缺乏已在临床实践中广泛采用。本综述的目的是评估这种策略的证据。
对 HIV 感染中维生素 D 缺乏、cART 对维生素 D 状态的影响以及维生素 D 缺乏和 cART 对甲状旁腺激素（PTH）、骨转换、BMD 和 HIV 阳性患者骨折发生率的影响进行了文献的系统评价。
使用 PubMed 确定截至 2011 年 9 月的相关文章。
维生素 D 缺乏、继发性甲状旁腺功能亢进和低 BMD 在 HIV 阳性患者中很常见。依非韦伦与 25-羟维生素 D 水平降低有关，替诺福韦与继发性甲状旁腺功能亢进有关，cART 与骨转换增加和低 BMD 有关。然而，BMD 降低的临床意义仍不清楚，尤其是在年轻患者中。尽管 HIV 阳性患者的骨折发生率可能增加，但低 BMD 和维生素 D 缺乏对这些骨折的贡献尚不确定。HIV 阳性患者中维生素 D 补充的有限数据表明，PTH 有短暂的有益作用，但对 BMD 没有影响。
在推荐将“检测和治疗”作为常规临床实践的一部分之前，需要证明该人群中维生素 D 补充的益处。
