Department of Pharmacotherapy, Washington State University, College of Pharmacy and Pharmaceutical Sciences, Yakima, WA, United States.
Department of Pharmacy Practice, University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, United States.
Curr HIV Res. 2021;19(1):61-72. doi: 10.2174/1570162X18666200827115615.
Vitamin D deficiency is common in HIV population and has been associated with increased comorbidity risk and poor immunologic status.
To evaluate the effect of protease inhibitor lopinavir/ritonavir monotherapy on changes in serum 25-hydroxyvitamin D [25(OH)D] over 48 weeks.
Thirty-four treatment-naïve HIV individuals initiating lopinavir/ritonavir monotherapy and receiving clinical care from private practice in Houston, Texas, were included. Serum 25-hydroxyvitamin D levels from stored plasma samples collected from IMANI-2 pilot study at both baseline and 48 weeks were analyzed using LC-MS assays. Mean 25(OH)D at baseline and 48 weeks were compared using paired t-tests. Linear regression analysis was used to evaluate factors associated with changes in 25(OH)D. Logistic regression analyses were used to determine the effect of vitamin D status and covariates on CD4 cell count recovery.
Mean 25(OH)D was significantly higher at 48 weeks (26.3 ng/mL (SD + 14.9); p=0.0003) compared to baseline (19.8 ng/mL (SD +12.1), with fewer individuals having vitamin D deficiency (41.2%) and severe deficiency (11.8%). Both body mass index and baseline CD4 cell count were significant independent covariates associated with 25(OH)D changes over 48 weeks. Baseline vitamin D status did not affect CD4 cell count recovery. However, in a 24-week multivariate analysis, current tobacco use was significantly associated with a decreased odds of CD4 cell count recovery (AOR 0.106, 95% CI 0.018-0.606; p=0.012).
Individuals treated with lopinavir/ritonavir monotherapy had significantly higher 25(OH)D after 48 weeks. Current tobacco users had significantly diminished CD4 cell count recovery after starting treatment, warranting further clinical investigation.
维生素 D 缺乏在 HIV 人群中很常见，并且与增加的合并症风险和较差的免疫状态有关。
评估蛋白酶抑制剂洛匹那韦/利托那韦单药治疗对 48 周内血清 25-羟维生素 D [25(OH)D]变化的影响。
纳入了 34 名在德克萨斯州休斯顿的私人诊所接受洛匹那韦/利托那韦单药治疗且初次接受治疗的 HIV 个体。使用 LC-MS 检测分析了来自 IMANI-2 试点研究的储存血浆样本中基线和 48 周时的血清 25-羟维生素 D 水平。使用配对 t 检验比较基线和 48 周时的平均 25(OH)D。使用线性回归分析评估与 25(OH)D 变化相关的因素。使用逻辑回归分析确定维生素 D 状态和协变量对 CD4 细胞计数恢复的影响。
与基线相比，48 周时的平均 25(OH)D 显著升高（26.3ng/mL（SD+14.9）；p=0.0003），且维生素 D 缺乏（41.2%）和严重缺乏（11.8%）的个体较少。体重指数和基线 CD4 细胞计数都是与 48 周内 25(OH)D 变化相关的独立重要协变量。基线维生素 D 状态并不影响 CD4 细胞计数的恢复。然而，在 24 周的多变量分析中，当前吸烟与 CD4 细胞计数恢复的几率降低显著相关（AOR 0.106，95%CI 0.018-0.606；p=0.012）。
接受洛匹那韦/利托那韦单药治疗的个体在 48 周后 25(OH)D 显著升高。开始治疗后，当前吸烟者的 CD4 细胞计数恢复明显下降，需要进一步的临床研究。
