Avihingsanon Anchalee, Apornpong Tanakorn, Ramautarsing Reshmie A, Ubolyam Sasiwimol, Tangkijvanich Pisit, Ananworanich Jintanat, Lange Joep M A, Matthews Gail, Lewin Sharon R, Ruxrungtham Kiat
HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Antivir Ther. 2014;19(1):41-9. doi: 10.3851/IMP2673. Epub 2013 Aug 23.
Vitamin D insufficiency plays an important role in the development of fibrosis in chronic liver disease.
This was a cross-sectional study from Thailand. Liver fibrosis was assessed by transient elastography. Serum 25 hydroxyvitamin D (25[OH]D)<30 ng/ml was defined as hypovitaminosis D. 25(OH)D was assessed prior to and following tenofovir disoproxil fumarate (TDF). Factors related to 25(OH)D levels were determined by logistic regression analysis.
A total of 158 HIV-HBV-coinfected patients (32% female, median age 43 years) were included. Overall, liver disease was mild with 13.4% having a fibrosis score (FS) of 7.1-14 kPa and 2% with a FS>14 kPa. Median (IQR) duration on TDF was 5 years (4-7). The median estimated glomerular filtration rate was 96.9 ml/min/1.73 m(2). The median (IQR) serum 25(OH)D levels prior to and following TDF were 24.8 ng/ml (21.3-30.6) and 22.8 ng/ml (18.0-27.7), respectively; P≤0.001). The proportion of patients with hypovitaminosis D significantly increased from 72.2% (95% CI 64.7, 78.6) prior to TDF to 84.2% (95% CI 77.7, 89.0) after taking TDF (P=0.01). Factors associated with hypovitaminosis D by multivariate analysis were female sex (adjusted OR 3.8, 95% CI 1.1, 13.7; P=0.038) and duration of antiretroviral therapy (ART)>5 years (OR 3.3, 95% CI 1.2, 8.8; P=0.017). Vitamin D levels were not associated with significant liver fibrosis.
Although our HIV-HBV-coinfected patients live in the tropics, there was a high prevalence of hypovitaminosis D, especially in female patients and those receiving prolonged ART. Since HIV-HBV-coinfection requires long-term use of the HBV-active drug, TDF, which can also contribute to bone loss, routine vitamin D assessment and supplementation as necessary should be considered.
维生素D不足在慢性肝病纤维化发展中起重要作用。
这是一项来自泰国的横断面研究。通过瞬时弹性成像评估肝纤维化。血清25羟维生素D（25[OH]D）<30 ng/ml被定义为维生素D缺乏症。在服用替诺福韦酯（TDF）之前和之后评估25(OH)D。通过逻辑回归分析确定与25(OH)D水平相关的因素。
共纳入158例HIV-HBV合并感染患者（女性占32%，中位年龄43岁）。总体而言，肝病较轻，13.4%的患者纤维化评分（FS）为7.1-14 kPa，2%的患者FS>14 kPa。TDF治疗的中位（IQR）持续时间为5年（4-7年）。估计肾小球滤过率中位数为96.9 ml/min/1.73 m²。TDF治疗前和治疗后血清25(OH)D水平的中位数（IQR）分别为24.8 ng/ml（21.3-30.6）和22.8 ng/ml（18.0-27.7）；P≤0.001）。维生素D缺乏症患者的比例从TDF治疗前的72.2%（95%CI 64.7, 78.6）显著增加至服用TDF后的84.2%（95%CI 77.7, 89.0）（P=0.01）。多因素分析显示，与维生素D缺乏症相关的因素为女性（调整后OR 3.8，95%CI 1.1, 13.7；P=0.038）和抗逆转录病毒治疗（ART）持续时间>5年（OR 3.3，95%CI 1.2, 8.8；P=0.017）。维生素D水平与显著肝纤维化无关。
尽管我们的HIV-HBV合并感染患者生活在热带地区，但维生素D缺乏症的患病率很高，尤其是女性患者和接受长期ART的患者。由于HIV-HBV合并感染需要长期使用具有抗HBV活性的药物TDF，而TDF也可能导致骨质流失，因此应考虑进行常规维生素D评估并在必要时进行补充。
