Das Satyajit, Bopitya Shyamalie, Chowdhury Ananya R, Das Archik, Taha Huda
Department of HIV Medicine, Coventry & Warwickshire Partnership Trust, Coventry, UK.
Recent Pat Antiinfect Drug Discov. 2016;11(1):59-67. doi: 10.2174/1574891x11666160201122236.
There is high prevalence of vitamin-D deficiency and abnormal bone mineral density (BMD) in HIV patients. Our aim is to find out the effect of replacement of low dose oral vitamin-D (800 International unit) with calcium (500mg) as a once daily regimen along with antiretroviral (ARV) on serum vitamin-D and parathyroid hormone (PTH) level and bone mineral density (BMD) changes on patients with HIV infection who have vitamin- D deficiency.
This is a non-randomised, open label study. We collected information about demography, viral load, CD-4 count, fracture risk factors. We measured serum 25(OH)D, parathyroid hormone (intact PTH), inorganic phosphate, corrected calcium, alkaline phosphatase (ALP) and BMD of hip and spine at baseline and after 12 months of routine follow up. Patients were treatment experienced and were divided into tenofovir containing, efavirenz containing, and protease Inhibitor (PI) containing regimens.
The study included 87 treatment experienced HIV patients with mean age 42.8 (+/-7.8) years, 55 (63%) females, 73 (84%) black African ethnicity, CD4 count 451.7 (+/-184.6) cells/dL, plasma VL 1.6 log (+/-0.03) copies/mL, exposure to antiretroviral therapy 43.2 (+/-30.2) months and duration of illness 58.4 (+/- 24.1) months. Forty four patients agreed to take vitamin-D with calcium replacement and 43 patients did not agree to take the replacement. After 12 months of follow up patients on vitamin D and calcium replacement (n=44) had significant increase in vitamin-D level (15.4+/-6.2 vs. 55.9+/-22.6, p=0.0001), reduction in PTH (8.04 +/-7.5, vs. 4.7 +/-1.8, p=0.005), alkaline phosphatase (111.1 +/-79.1 vs. 90.2+/-42.2, p=0.038) and increase in corrected calcium (2.18 +/-0.09 vs. 2.19 +/-0.09 p=0.001). In patients not on vitamin-D replacement (n=43), there was increase in vitamin-D (16.9 +/-12.1 vs. 49.4 +/-29.2, p=0.001) and corrected calcium (2.12 +/-0.09 vs. 2.16 +/-0.08 p=0.0001) level, but PTH and ALP did not change. BMD of hip and spine did not show any significant change in either of the two groups. In multivariate analysis that included all significant variables, vitamin-D and calcium replacement independently was associated with increase in vitamin-D level (OR 1.07, CI 1.02, 1.12, p=0.005), decrease in PTH level (OR 0.53, CI 0.35, 0.82, p=0.004), but not with change in corrected calcium, alkaline phosphatase, BMD of hip or spine.
After 12 months of follow up, replacement of low dose once daily oral vitamin-D with calcium in treatment experienced HIV patients with vitamin-D deficiency can increase vitamin-D level, reduce PTH level without any change in BMD of hip and spine.
HIV患者中维生素D缺乏和骨矿物质密度（BMD）异常的患病率很高。我们的目的是研究在接受抗逆转录病毒（ARV）治疗的维生素D缺乏的HIV感染患者中，每日一次服用低剂量口服维生素D（800国际单位）加钙（500毫克）的方案对血清维生素D、甲状旁腺激素（PTH）水平以及骨矿物质密度（BMD）变化的影响。
这是一项非随机、开放标签的研究。我们收集了人口统计学、病毒载量、CD4细胞计数、骨折风险因素等信息。在基线和常规随访12个月后，我们测量了血清25（OH）D、甲状旁腺激素（完整PTH）、无机磷、校正钙、碱性磷酸酶（ALP）以及髋部和脊柱的骨矿物质密度（BMD）。患者均有治疗经历，分为含替诺福韦方案组、含依非韦伦方案组和含蛋白酶抑制剂（PI）方案组。
该研究纳入了87例有治疗经历的HIV患者，平均年龄42.8（±7.8）岁，55例（63%）为女性，73例（84%）为非洲黑人，CD4细胞计数为451.7（±184.6）个/微升，血浆病毒载量为1.6 log（±0.03）拷贝/毫升，接受抗逆转录病毒治疗的时间为43.2（±30.2）个月，患病时间为58.4（±24.1）个月。44例患者同意服用维生素D加钙补充剂，43例患者不同意服用。随访12个月后，服用维生素D和钙补充剂的患者（n = 44）维生素D水平显著升高（15.4±6.2 vs. 55.9±22.6，p = 0.0001），PTH降低（8.04±7.5 vs. 4.7±1.8，p = 0.005），碱性磷酸酶降低（111.1±79.1 vs. 90.2±42.2，p = 0.038），校正钙升高（2.18±0.09 vs. 2.19±0.09，p = 0.001）。未服用维生素D补充剂的患者（n = 43）维生素D水平（16.9±12.1 vs. 49.4±29.2，p = 0.001）和校正钙水平（2.12±0.09 vs. 2.16±0.08，p = 0.0001）升高，但PTH和ALP没有变化。两组患者的髋部和脊柱骨矿物质密度均未显示出任何显著变化。在包含所有显著变量的多变量分析中，维生素D和钙补充剂独立地与维生素D水平升高相关（OR 1.07，CI 1.02，1.12，p = 0.005），与PTH水平降低相关（OR 0.53，CI 0.35，0.82，p = 0.004），但与校正钙、碱性磷酸酶、髋部或脊柱骨矿物质密度的变化无关。
随访12个月后，在有治疗经历的维生素D缺乏的HIV患者中，每日一次服用低剂量口服维生素D加钙可以提高维生素D水平，降低PTH水平，而髋部和脊柱的骨矿物质密度没有变化。
