Department of Clinical and Molecular Biomedicine, University of Catania, Italy.
Eur Rev Med Pharmacol Sci. 2013 May;17(9):1218-32.
Hypovitaminosis D is a very common disorder, regarding both Western and developing countries. A growing amount of data over the last years have shown vitamin D deficiency to be high prevalent among HIV-positive subjects. In addition to "classic" risk factors, such as female sex, low dietary intake, dark skin pigmentation and low sun exposure, HIV-related factors, including immune activation and antiretroviral adverse effects, may affect vitamin D status. Even if both protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been associated with low vitamin D levels, available evidences have failed to univocally associate hypovitaminosis D with specific antiretroviral class effects. Low vitamin D is known to have a negative impact not only on bone health, but also on neurocognitive, metabolic, cardiovascular and immune functions. Similarly to the general population, several studies conducted on HIV-infected subjects have associated hypovitaminosis D with a greater risk of developing osteopenia/osteoporosis and fragility fractures. Analogously, vitamin D deficiency has been described as an independent risk factor for cardiovascular disease and metabolic disorders, such as insulin resistance and type 2 diabetes mellitus. Last EACS guidelines suggest to screen for hypovitaminosis D every HIV-positive subject having a history of bone disease, chronic kidney disease or other known risk factors for vitamin D deficiency. Vitamin D repletion is recommended when 25-hydroxyvitamin D levels are below 10 ng/ml. Furthermore, it may be indicated in presence of 25OHD values between 10 and 30 ng/ml, if associated with osteoporosis, osteomalacia or increased parathyroid hormone levels. The optimal repletion and maintenance dosing regimens remain to be established, as well as the impact of vitamin D supplementation in preventing comorbidities.
维生素 D 缺乏症是一种非常常见的疾病，无论是在西方国家还是发展中国家都有很高的发病率。近年来越来越多的数据表明，HIV 阳性患者中维生素 D 缺乏症的患病率很高。除了女性、低饮食摄入、深色皮肤色素沉着和低日照暴露等“经典”危险因素外，HIV 相关因素，包括免疫激活和抗逆转录病毒的不良反应，也可能影响维生素 D 状态。虽然蛋白酶抑制剂和非核苷类逆转录酶抑制剂都与低维生素 D 水平有关，但现有的证据未能明确将维生素 D 缺乏症与特定的抗逆转录病毒药物类别联系起来。众所周知，低维生素 D 不仅对骨骼健康有负面影响，而且对神经认知、代谢、心血管和免疫功能也有负面影响。与普通人群一样，几项针对 HIV 感染患者的研究表明，维生素 D 缺乏症与骨量减少/骨质疏松症和脆性骨折的风险增加有关。同样，维生素 D 缺乏症被描述为心血管疾病和代谢紊乱（如胰岛素抵抗和 2 型糖尿病）的独立危险因素。最新的 EACS 指南建议对有骨骼疾病、慢性肾脏病或其他已知维生素 D 缺乏危险因素的 HIV 阳性患者进行维生素 D 缺乏筛查。当 25-羟维生素 D 水平低于 10ng/ml 时，建议补充维生素 D。此外，如果伴有骨质疏松症、骨软化症或甲状旁腺激素水平升高，25OHD 值在 10 至 30ng/ml 之间也建议补充维生素 D。最佳补充和维持剂量方案仍有待确定，以及维生素 D 补充在预防合并症方面的影响。
