维生素 D 缺乏及其与低骨密度、HIV 相关因素、住院和死亡的关系，在以黑人为主要感染人群的 HIV 感染队列中。
Vitamin D deficiency and its association with low bone mineral density, HIV-related factors, hospitalization, and death in a predominantly black HIV-infected cohort.
机构信息
Department of Medicine, William Beaumont Army Medical Center, El Paso, Texas, USA.
出版信息
Clin Infect Dis. 2012 Dec;55(12):1727-36. doi: 10.1093/cid/cis785. Epub 2012 Sep 12.
BACKGROUND
Low bone mineral density (BMD) is common among patients infected with human immunodeficiency virus (HIV) and present in higher rates in black subjects. This study assessed vitamin D levels in HIV cases versus noninfected matched controls to determine if deficiency was associated with BMD and HIV clinical outcomes.
METHODS
In total, 271 military beneficiaries with HIV underwent dual energy x-ray absorptiometry (DEXA) screening in 2001-2. Serum 25OH-vitamin D levels were determined using stored serum from the time of DEXA and 6-18 months prior. Two non-HIV-infected controls for each active duty case (n = 205) were matched on age, sex, race, zip code, and season using the Department of Defense Serum Repository (DoDSR). Vitamin D levels <20 ng/mL were considered deficient. HIV-related factors and clinical outcomes were assessed using data collected in the DoD HIV Natural History study.
RESULTS
In total, 165 of 205 (80.5%) active duty HIV cases had 2 matched controls available. HIV cases had greater odds of for vitamin D deficiency (VDD) compared with controls (demographics adjusted paired data odds ratio [OR], 1.46, 95% confidence interval [CI], .87-2.45), but this was not statistically significant. Blacks were disproportionately deficient (P <.001) but not relative to HIV status or BMD. Low BMD was associated with typical risk factors (low body mass index and exercise levels, alcohol use); given limited available data the relationship between tenofovir exposure and VDD or low BMD could not be determined. Analysis of HIV-specific factors and outcomes such as exposure to antiretrovirals, HIV progression, hospitalizations, and death revealed no significant associations with vitamin D levels.
CONCLUSIONS
VDD was highly prevalent in black HIV- infected persons but did not explain the observed racial disparity in BMD. Vitamin D deficiency was not more common among HIV- infected persons, nor did it seem associated with HIV- related factors/clinical outcomes.
背景
人类免疫缺陷病毒（HIV）感染者中普遍存在骨矿物质密度（BMD）低的情况，且黑人患者中发生率更高。本研究评估了 HIV 病例与未感染的匹配对照者的维生素 D 水平，以确定缺乏是否与 BMD 和 HIV 临床结局相关。
方法
2001 年至 2002 年，共有 271 名 HIV 现役军人接受了双能 X 射线吸收法（DEXA）筛查。利用 DEXA 时及之前 6-18 个月储存的血清，检测血清 25OH-维生素 D 水平。采用国防部血清库（DoDSR），按年龄、性别、种族、邮政编码和季节，为每位现役 HIV 病例匹配 2 名非 HIV 感染对照者（n = 205）。维生素 D 水平<20ng/ml 被认为是缺乏。使用从 DoD HIV 自然史研究中收集的数据评估 HIV 相关因素和临床结局。
结果
205 名现役 HIV 病例中，共有 165 名（80.5%）有 2 名匹配对照者。与对照组相比，HIV 病例发生维生素 D 缺乏（VDD）的可能性更高（调整人口统计学因素后的配对数据比值比[OR]，1.46，95%置信区间[CI]，0.87-2.45），但无统计学意义。黑人的 VDD 比例不成比例（P<.001），但与 HIV 状态或 BMD 无关。低 BMD 与典型的危险因素（低体重指数和运动水平、饮酒）相关；鉴于有限的可用数据，无法确定替诺福韦暴露与 VDD 或低 BMD 之间的关系。对 HIV 特异性因素和结局（如抗逆转录病毒药物暴露、HIV 进展、住院和死亡）的分析显示，维生素 D 水平与这些因素或结局之间无显著相关性。
结论
黑人 HIV 感染者中 VDD 非常普遍，但不能解释 BMD 中观察到的种族差异。HIV 感染者中 VDD 并不更常见，也似乎与 HIV 相关因素/临床结局无关。
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