High Prevalence of Vitamin D Deficiency in HIV Infected on Antiretroviral Therapy in a Cohort of Indian Patients.

OBJECTIVES

The main aim of this study was to assess vitamin D [25(OH)D]levels in an HIV infected adult population and to define HIV and antiretroviral-related factors associated with vitamin D deficiency.

METHODS

This observational analytical study was conducted on 475 adult patients on follow up at Apex Immunodeficiency Center of Base Hospital, Delhi Cantt. We estimated the prevalence of vitamin D insufficiency/deficiency(<30 ng/ml). Age, gender, BMI, CD4 count, plasma viral load, HBV/HCV coinfection, smoking status, time since diagnosis of HIV infection and selected liver enzymes were recorded. Antiretroviral therapy regimen was taken into account and its relationship with vitamin D levels were noted.

RESULTS

Vitamin D insufficiency/deficiency was noted in 92.63% of patients out of which 65.68 % were males. Median age of vitamin D sufficient group was slightly higher(52.11 vs 49.95). Patients with higher body mass index (BMI) had a slightly higher rates of Vitamin D insufficiency(24.2 vs 22.3). More the time interval from the date of diagnosis higher were the chances of deficiency/insufficiency. Co-infected patients with hepatitis B and C had sufficient vitamin D levels in 71.92% patients. Efavirenz(66.93%), nevirapine(79.02%), tenofovir(64.84%) and ritonavir(84.90%) containing regimens had consistently low levels of vitamin D. Abnormal liver enzymes viz alanine aminotransferase, alkaline phosphatase and gamma glutamyl transferase were associated with higher rates of deficient vitamin D levels.

CONCLUSIONS

Vitamin D deficiency is very high in HIV patients on antiretroviral therapy. . Efavirenz (EFV), Nevirapine (NVP), Tenofovir (TDF) and Protease Inhibitors (PI's) were associated with high levels of deficiency/insufficiency of vitamin D levels. Vitamin D supplementation as a global strategy in all HIV positive patients on antiretroviral therapy is advocated.