Longenecker Chris T, Hileman Corrilynn O, Carman Teresa L, Ross Allison C, Seydafkan Shabnam, Brown Todd T, Labbato Danielle E, Storer Norma, Tangpricha Vin, McComsey Grace A
University Hospitals Case Medical Center, Cleveland, OH, USA.
Antivir Ther. 2012;17(4):613-21. doi: 10.3851/IMP1983. Epub 2011 Nov 17.
Studies suggest that vitamin D deficiency is a risk factor for cardiovascular disease and diabetes. Vitamin D deficiency is prevalent in HIV patients but the effect of vitamin D supplementation on cardiovascular risk in this population is unknown.
We conducted a randomized, double-blind, placebo-controlled trial among 45 HIV-infected adults in Cleveland (OH, USA) on stable antiretroviral therapy with durable virological suppression and a baseline serum 25-hydroxyvitamin D level of ≤20 ng/ml. Participants were randomized 2:1 to vitamin D3 4,000 IU daily or placebo for 12 weeks. The primary outcome was a change in flow-mediated brachial artery dilation (FMD).
Baseline demographics were similar except for age (vitamin D versus placebo, mean ±sd 47 ±8 versus 40 ±10 years; P=0.009). Both groups had reduced FMD at baseline (median values 2.9% [IQR 1.6-4.8] for vitamin D versus 2.5% [IQR 1.7-6.4] for placebo; P=0.819). Despite an increase in the concentration of serum 25-hydroxyvitamin D from baseline to 12 weeks (5.0 ng/ml [IQR -0.9-7.4] versus -1.9 ng/ml [IQR -4.0-0.1] for vitamin D versus placebo, respectively; P=0.003), there was no difference in FMD change (0.55% [IQR -1.05-2.13] versus 0.29% [IQR -1.61-1.77]; P=0.748). Vitamin D supplementation was associated with a decrease in total and non-high-density lipoprotein cholesterol, and an increase in indices of insulin resistance.
Among HIV-infected individuals with vitamin D deficiency, supplementation with 4,000 IU vitamin D3 daily for 12 weeks modestly improved vitamin D status and cholesterol but worsened insulin resistance without change in endothelial function. The mechanisms of resistance to standard doses of vitamin D and the complex role of vitamin D in glucose metabolism in this population require further investigation.
研究表明维生素D缺乏是心血管疾病和糖尿病的一个风险因素。维生素D缺乏在HIV患者中很普遍，但维生素D补充剂对该人群心血管风险的影响尚不清楚。
我们在美国俄亥俄州克利夫兰对45名接受稳定抗逆转录病毒治疗且病毒学抑制持久、基线血清25-羟基维生素D水平≤20 ng/ml的HIV感染成年人进行了一项随机、双盲、安慰剂对照试验。参与者按2:1随机分为每日服用4000 IU维生素D3组或安慰剂组，为期12周。主要结局是血流介导的肱动脉扩张（FMD）的变化。
除年龄外，基线人口统计学特征相似（维生素D组与安慰剂组，平均±标准差 47±8岁与40±10岁；P = 0.009）。两组在基线时FMD均降低（维生素D组中位数为2.9%[四分位间距1.6 - 4.8]，安慰剂组为2.5%[四分位间距1.7 - 6.4]；P = 0.819）。尽管从基线到12周血清25-羟基维生素D浓度有所增加（维生素D组为5.0 ng/ml[四分位间距 - 0.9 - 7.4]，安慰剂组为 - 1.9 ng/ml[四分位间距 - 4.0 - 0.1]；P = 0.003），但FMD变化无差异（0.55%[四分位间距 - 1.05 - 2.13]与0.29%[四分位间距 - 1.61 - 1.77]；P = 0.748）。补充维生素D与总胆固醇和非高密度脂蛋白胆固醇降低以及胰岛素抵抗指数增加有关。
在维生素D缺乏的HIV感染个体中，每日补充4000 IU维生素D3持续12周可适度改善维生素D状态和胆固醇，但会加重胰岛素抵抗，而内皮功能无变化。该人群对标准剂量维生素D产生抵抗的机制以及维生素D在葡萄糖代谢中的复杂作用需要进一步研究。
