Prevalence and Causes of Vitamin D Deficiency in a Cohort of Greek HIV-Infected Individuals: A Prospective, Single Center, Observational Study


Citar

Texto integral

Resumo

Background:Vitamin D deficiency and/or insufficiency (hypovitaminosis D) has been associated with several disorders including autoimmune diseases, like type 1 diabetes mellitus; cardiovascular diseases; neoplasms; obesity; insulin resistance, and type 2 diabetes mellitus. This problem is common in southern European countries, especially in elderly and institutionalized persons. In HIV-infected individuals, hypovitaminosis D has been correlated with various complications like tuberculosis, hyperparathyroidism, bone mass loss, premature atherosclerosis, and systemic arterial hypertension, deterioration of immune function, progression of the disease and overall mortality.

Objective:The objective of this study was to examine the prevalence and causes of hypovitaminosis D in a cohort of Greek HIV-infected patients, the factors, and possible complications associated with it.

Methods:All patients attending our HIV unit for a period of 5 months were included in this study. Vitamin D status, medical anamnes, and laboratory tests were obtained at baseline; patients were followed for 3 years and HIV-related complications were noted. No patient received vitamin D supplementation during the follow-up period.

Results:Hypovitaminosis D was common, with 83.7% of the patients showing levels below 30ng/dl and 55.4% below 20ng/dl. After multivariable analysis, age and duration of treatment were the only significant factors for low vitamin D levels. During follow-up, 26 patients exhibited a total of 34 HIV-related complications, the most common being pneumonocystis jiroveci pneumonia (PCP). Hypovitaminosis D showed a positive correlation with overall complications, PCP as well as wasting syndrome.

Conclusion:Overall, our study shows that hypovitaminosis D is common in HIV-infected individuals and should probably be treated as soon as possible to protect these patients from serious HIVrelated complications like PCP or wasting syndrome.

Sobre autores

Theodoros Androutsakos

Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens

Autor responsável pela correspondência
Email: info@benthamscience.net

Marianna Politou

Hematology Laboratory-Blood Bank at the Aretaieion Hospital, Second Department of Hematology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

Sofia Boti

Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

Theodoros Pittaras

Hematology Laboratory-Blood Bank at the Aretaieion Hospital, Second Department of Hematology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

Athanasios Kontos

Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

Theodore Kordossis

Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

Abraham Pouliakis

Second Department of Pathology, Medical School, National and Kapodistrian University of Athens

Email: info@benthamscience.net

George Panayiotakopoulos

Department of Pharmacology, Medical School, University of Patras

Email: info@benthamscience.net

Bibliografia

  1. Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010; 95(2): 471-8. doi: 10.1210/jc.2009-1773 PMID: 20133466
  2. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab 2009; 94(1): 26-34. doi: 10.1210/jc.2008-1454 PMID: 18854395
  3. Oyedele T, Adeyemi OM. High prevalence of vitamin D deficiency in HIV-infected adults: What are the future research questions? Curr HIV/AIDS Rep 2012; 9(1): 1-4. doi: 10.1007/s11904-011-0101-9 PMID: 22187389
  4. Saraiva GL, Cendoroglo MS, Ramos LR. Prevalência da deficiência, insuficiência de vitamina D e hiperparatireoidismo secundário em idosos institucionalizados e moradores na comunidade da cidade de São Paulo, Brasil. Arq Bras Endocrinol Metab 2010; 51(3): 12.
  5. Canuto JMP, Canuto VMP, Lima MHA, et al. Risk factors associated with hypovitaminosis D in HIV/aids-infected adults. Arch Endocrinol Metab 2015; 59(1): 34-41. doi: 10.1590/2359-3997000000007 PMID: 25926112
  6. Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: An update on the current status worldwide. Eur J Clin Nutr 2020; 74(11): 1498-513. doi: 10.1038/s41430-020-0558-y PMID: 31959942
  7. Choi AI, Lo JC, Mulligan K, et al. Association of vitamin D insufficiency with carotid intima-media thickness in HIV-infected persons. Clin Infect Dis 2011; 52(7): 941-4. doi: 10.1093/cid/ciq239 PMID: 21273298
  8. Greene-Finestone LS, Berger C, de Groh M, et al. 25-Hydroxyvitamin D in Canadian adults: Biological, environmental, and behavioral correlates. Osteoporos Int 2011; 22(5): 1389-99. doi: 10.1007/s00198-010-1362-7 PMID: 20730415
  9. Lai YC, Chen YH, Liang FW, et al. Determinants of cancer incidence and mortality among people with vitamin D deficiency: An epidemiology study using a real-world population database. Front Nutr 2023; 10: 1294066. doi: 10.3389/fnut.2023.1294066 PMID: 38130443
  10. Hendriks S, Ranson JM, Peetoom K. Risk factors for young-onset dementia in the UK Biobank. JAMA Neurol 2023; 81(2): 134-42. doi: 10.1001/jamaneurol.2023.4929 PMID: 38147328
  11. Samanta I, Patil DJ, More CB. Assessment of vitamin D levels in patients with oral potentially malignant disorders and oral squamous cell carcinoma-A cross-sectional study. J Oral Biol Craniofac Res 2024; 14(1): 27-32. doi: 10.1016/j.jobcr.2023.11.005 PMID: 38130424
  12. Camargo CA Jr, Schaumberg DA, Friedenberg G, et al. Effect of daily vitamin D supplementation on risk of upper respiratory infection in older adults: A randomized controlled trial. Clin Infect Dis. Clin Infect Dis 2024; 78(5): 1162-9. doi: 10.1093/cid/ciad770
  13. Jiang L, Zhi S, Wei C, Rong Z, Zhang H. Serum 25(OH)D levels are associated with disease activity and renal involvement in initial-onset childhood systemic lupus erythematosus. Front Pediatr 2023; 11: 1252594. doi: 10.3389/fped.2023.1252594 PMID: 38111622
  14. Abukanna AMA, Alanazi RFA, Alruwaili FS, Alayyashi AZM, Alanzi F, Vitamin D. Vitamin D deficiency as a risk factor for diabetes and poor glycemic control in Saudi Arabia: A systematic review. Cureus 2023; 15(11): e48577. doi: 10.7759/cureus.48577 PMID: 38073984
  15. Kim MS, Lee JS, Chung SJ, Soh Y. Association between vitamin D and short-term functional outcomes in acute ischemic stroke. Nutrients 2023; 15(23): 4957. doi: 10.3390/nu15234957 PMID: 38068815
  16. Liu J, Tian C, Tang Y, Geng B. Associations of the serum vitamin D with mortality in postmenopausal women. Clin Nutr 2024; 43(1): 211-7. doi: 10.1016/j.clnu.2023.11.041 PMID: 38086258
  17. Chen CW, Han YY, Hwang JS, et al. Association between adequate serum 25(OH)D levels and atherogenic dyslipidemia in young adults. J Atheroscler Thromb 2023; 31(5): 524-39. doi: 10.5551/jat.64523 PMID: 38057082
  18. Aagaard K, Møllegaard Jepsen JR, Sevelsted A. High-dose vitamin D3 supplementation in pregnancy and risk of neurodevelopmental disorders in the children at age 10: A randomized clinical trial. Am J Clin Nutr 2024; 119(2): 362-70. doi: 10.1016/j.ajcnut.2023.12.002
  19. Massa A, Isasi-Fuster A, Requena C, Manrique-Silva E, Kumar R, Nagore E. Nodular type but not vitamin D Levels increases the risk of second primary cancers in melanoma patients: An observational study of 663 patients. Actas Dermosifiliogr 2024; 115(2): T143-9. doi: 10.1016/j.ad.2023.10.038
  20. Arnqvist HJ, Leanderson P, Spångeus A. Vitamin D status in longstanding type 1 diabetes and controls. Association with upper extremity impairments. Ups J Med Sci 2023; 128 doi: 10.48101/ujms.v128.9888 PMID: 38084202
  21. Boggess KA, Espinola JA, Moss K, Beck J, Offenbacher S, Camargo CA Jr. Vitamin D status and periodontal disease among pregnant women. J Periodontol 2011; 82(2): 195-200. doi: 10.1902/jop.2010.100384 PMID: 20809861
  22. Haugen M, Brantsæter AL, Trogstad L, et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology 2009; 20(5): 720-6. doi: 10.1097/EDE.0b013e3181a70f08 PMID: 19451820
  23. Maghbooli Z, Hossein-nezhad A, Karimi F, Shafaei AR, Larijani B. Correlation between vitamin D 3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24(1): 27-32. doi: 10.1002/dmrr.737 PMID: 17607661
  24. Bodnar LM, Catov JM, Zmuda JM, et al. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr 2010; 140(5): 999-1006. doi: 10.3945/jn.109.119636 PMID: 20200114
  25. Viljakainen HT, Korhonen T, Hytinantti T, et al. Maternal vitamin D status affects bone growth in early childhood—a prospective cohort study. Osteoporos Int 2011; 22(3): 883-91. doi: 10.1007/s00198-010-1499-4 PMID: 21153404
  26. Belderbos ME, Houben ML, Wilbrink B, et al. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics 2011; 127(6): e1513-20. doi: 10.1542/peds.2010-3054 PMID: 21555499
  27. Díaz-López A, Paz-Graniel I, Alonso-Sanz R, Marqués Baldero C, Mateos Gil C, Arija Val V. Vitamin D deficiency in primary health care users at risk in Spain. Nutr Hosp 2021; 38(5): 1058-67. doi: 10.20960/nh.03565
  28. Díaz-Rizzolo DA, Kostov B, Gomis R, Sisó-Almirall A. Paradoxical suboptimal vitamin D levels in a Mediterranean area: A population-based study. Sci Rep 2022; 12(1): 19645. doi: 10.1038/s41598-022-23416-1 PMID: 36385623
  29. Souberbielle JC, Massart C, Brailly-Tabard S, Cavalier E, Chanson P. Prevalence and determinants of vitamin D deficiency in healthy French adults: The VARIETE study. Endocrine 2016; 53(2): 543-50. doi: 10.1007/s12020-016-0960-3 PMID: 27106800
  30. Galeazzi T, Quattrini S, Pjetraj D, et al. Vitamin D status in healthy Italian school-age children: A single-center cross-sectional study. Ital J Pediatr 2023; 49(1): 27. doi: 10.1186/s13052-023-01422-x PMID: 36814347
  31. Morsilli O, Guerriero R, Palmieri L, et al. Vitamin D status in a rural italian population. Reports 2021; 5(1): 1. doi: 10.3390/reports5010001
  32. Capuano R, Marchese F, Sica R, et al. Epidemiologic data of vitamin D deficiency and its implication in cardio-cerebrovascular risk in a Southern Italian Population. J Nutr Metab 2021; 2021: 1-8. doi: 10.1155/2021/5550222 PMID: 34211785
  33. Challa A, Ntourntoufi A, Cholevas V, Bitsori M, Galanakis E, Andronikou S. Breastfeeding and vitamin D status in Greece during the first 6 months of life. Eur J Pediatr 2005; 164(12): 724-9. doi: 10.1007/s00431-005-1757-1 PMID: 16143866
  34. Lapatsanis D, Moulas A, Cholevas V, et al. Vitamin D: A necessity for children and adolescents in Greece. Calcif Tissue Int 2005; 77(6): 348-55. doi: 10.1007/s00223-004-0096-y PMID: 16362463
  35. Xyda SE, Kotsa K, Doumas A, Papanastasiou E, Garyfallos AA, Samoutis G. Could the majority of the greek and cypriot population be Vitamin D deficient? Nutrients 2022; 14(18): 3778. doi: 10.3390/nu14183778 PMID: 36145154
  36. Bouloukaki I, Markakis M, Pateli R, Lyronis I, Schiza S, Tsiligianni I. Vitamin D levels in primary care patients: Correlations with clinical, seasonal, and quality-of-life parameters. Fam Pract 2022; 39(4): 678-84. doi: 10.1093/fampra/cmac012 PMID: 35325110
  37. Mehta S, Mugusi FM, Spiegelman D, et al. Vitamin D status and its association with morbidity including wasting and opportunistic illnesses in HIV-infected women in Tanzania. AIDS Patient Care STDS 2011; 25(10): 579-85. doi: 10.1089/apc.2011.0182 PMID: 21916603
  38. Szep Z, Guaraldi G, Shah SS, et al. Vitamin D deficiency is associated with type 2 diabetes mellitus in HIV infection. AIDS 2011; 25(4): 525-9. doi: 10.1097/QAD.0b013e328342fdfd PMID: 21178753
  39. Hileman CO, Overton ET, McComsey GA. Vitamin D and bone loss in HIV. Curr Opin HIV AIDS 2016; 11(3): 277-84. doi: 10.1097/COH.0000000000000272 PMID: 26890209
  40. Nguyen HS, Van Tran K, Chen SY, Tam KW. A systematic review and meta-analysis of randomized controlled trials of the effects of vitamin D supplementation on children and young adults with HIV infection. J Nutr 2023; 153(1): 138-47. doi: 10.1016/j.tjnut.2022.10.008 PMID: 36913447
  41. Viard JP, Souberbielle JC, Kirk O. Vitamin D and clinical disease progression in HIV infection: Results from the EuroSIDA study. AIDS 2011; 25(10): 1305-5.
  42. Jiménez-Sousa MÁ, Martínez I, Medrano LM, Fernández-Rodríguez A, Resino S. Vitamin D in human immunodeficiency virus infection: Influence on immunity and disease. Front Immunol 2018; 9: 458. doi: 10.3389/fimmu.2018.00458 PMID: 29593721
  43. Shepherd L, Souberbielle JC, Bastard JP, et al. Prognostic value of vitamin D level for all-cause mortality, and association with inflammatory markers, in HIV-infected persons. J Infect Dis 2014; 210(2): 234-43. doi: 10.1093/infdis/jiu074 PMID: 24493824
  44. Verma P, Shrivastava A, Siddiqui SA, et al. Effect of vitamin D supplementation on CD4 count in HIV-infected children and adolescents in North India: A non-randomized comparative study. J Trop Pediatr 2022; 68(5): fmac066. doi: 10.1093/tropej/fmac066 PMID: 35944184
  45. Lee S, Lee JE, Lee SO, Sim YK, Lee SH. Influence of vitamin D deficiency on the development of opportunistic infection in people living with HIV/AIDS (PWHAs). J Am Coll Nutr 2021; 40(6): 545-50. doi: 10.1080/07315724.2020.1805043 PMID: 32790581
  46. Calza L, Borderi M, Granozzi B, et al. Vitamin D insufficiency is associated with subclinical atherosclerosis in HIV-1-infected patients on combination antiretroviral therapy. HIV Res Clin Pract 2019; 20(6): 131-9. doi: 10.1080/25787489.2020.1724749 PMID: 32065065
  47. Cheru LT, Saylor CF, Fitch KV, et al. Low vitamin D is associated with coronary atherosclerosis in women with HIV. Antivir Ther 2019; 24(7): 505-12. doi: 10.3851/IMP3336 PMID: 31742564
  48. Welz T, Childs K, Ibrahim F, et al. Efavirenz is associated with severe vitamin D deficiency and increased alkaline phosphatase. AIDS 2010; 24(12): 1923-8. doi: 10.1097/QAD.0b013e32833c3281 PMID: 20588161
  49. Nylén H, Habtewold A, Makonnen E, et al. Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency. Medicine (Baltimore) 2016; 95(34): e4631. doi: 10.1097/MD.0000000000004631 PMID: 27559961
  50. Havers FP, Detrick B, Cardoso SW, et al. Change in vitamin d levels occurs early after antiretroviral therapy initiation and depends on treatment regimen in resource-limited settings. PLoS One 2014; 9(4): e95164. doi: 10.1371/journal.pone.0095164 PMID: 24752177
  51. Legeai C, Vigouroux C, Souberbielle JC, et al. Associations between 25-hydroxyvitamin D and immunologic, metabolic, inflammatory markers in treatment-naive HIV-infected persons: The ANRS CO9 «COPANA» cohort study. PLoS One 2013; 8(9): e74868. doi: 10.1371/journal.pone.0074868 PMID: 24058636
  52. Dao CN, Patel P, Overton ET, et al. Low vitamin D among HIV-infected adults: Prevalence of and risk factors for low vitamin D Levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clin Infect Dis 2011; 52(3): 396-405. doi: 10.1093/cid/ciq158 PMID: 21217186
  53. Visuthranukul J, Phansuea P, Buranakityanon P, Lerdrungroj P, Yamasmith E. Prevalence and risk factors of vitamin D deficiency among living with HIV adults receiving antiretroviral treatment in tropical area: Cross-sectional study. Heliyon 2023; 9(9): e19537. doi: 10.1016/j.heliyon.2023.e19537 PMID: 37809448
  54. Wang Y, Huang X, Wu Y, et al. Increased risk of vitamin D deficiency among HIV-infected individuals: A systematic review and meta-analysis. Front Nutr 2021; 8: 722032. doi: 10.3389/fnut.2021.722032 PMID: 34490331
  55. Kanwal W, Rehman A. High prevalence of vitamin D deficiency in HIV-infected individuals in comparison with the general population across Punjab province, Pakistan. Saudi J Biol Sci 2023; 30(1): 103484. doi: 10.1016/j.sjbs.2022.103484 PMID: 36387030
  56. Havens PL, Tamhane A, Stephensen CB, et al. Short communication: Association of vitamin D Insufficiency and protective tenofovir diphosphate concentrations with bone toxicity in adolescent boys and young men using tenofovir disoproxil fumarate/emtricitabine for HIV pre-exposure prophylaxis. AIDS Res Hum Retroviruses 2019; 35(2): 123-8. doi: 10.1089/aid.2018.0096 PMID: 30280906
  57. Calza L, di Pietro G, Colangeli V, et al. Factors associated with vitamin D deficiency in HIV-1 infected patients on combination antiretroviral therapy: A case-control study. New Microbiol 2019; 42(3): 145-9. PMID: 31305932
  58. Mikuła T, Sapuła M, Suchacz MM, et al. Risk factors of hypovitaminosis D in HIV-infected patients on suppressive antiretroviral therapy. AIDS Res Hum Retroviruses 2020; 36(8): 676-80. doi: 10.1089/aid.2019.0020 PMID: 32408752
  59. Arpadi SM, Shiau S, Strehlau R, et al. Efavirenz is associated with higher bone mass in South African children with HIV. AIDS 2016; 30(16): 2459-67. doi: 10.1097/QAD.0000000000001204 PMID: 27427876
  60. Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged
  61. Theodorou M, Sersté T, Van Gossum M, Dewit S. Factors associated with vitamin D deficiency in a population of 2044 HIV-infected patients. Clin Nutr 2014; 33(2): 274-9. doi: 10.1016/j.clnu.2013.04.018 PMID: 23680190
  62. Cervero M, Agud JL, García-Lacalle C, et al. Prevalence of vitamin D deficiency and its related risk factor in a Spanish cohort of adult HIV-infected patients: Effects of antiretroviral therapy. AIDS Res Hum Retroviruses 2012; 28(9): 963-71. doi: 10.1089/aid.2011.0244 PMID: 22242918
  63. Crutchley RD, Gathe J Jr, Mayberry C, Trieu A, Abughosh S, Garey KW. Risk factors for vitamin D deficiency in HIV-infected patients in the south central United States. AIDS Res Hum Retroviruses 2012; 28(5): 454-9.
  64. Aziz M, Livak B, Burke-Miller J, et al. Vitamin D insufficiency may impair CD4 recovery among Women's Interagency HIV Study participants with advanced disease on HAART. AIDS 2013; 27(4): 573-8. doi: 10.1371/journal.pone.0222878 PMID: 31550271
  65. Ezeamama AE, Guwatudde D, Wang M, et al. Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: A longitudinal study. Clin Nutr 2016; 35(5): 1110-7. doi: 10.1016/j.clnu.2015.08.007 PMID: 26371397
  66. Kim JH, Gandhi V, Psevdos G Jr, Espinoza F, Park J, Sharp V. Evaluation of vitamin D levels among HIV-infected patients in New York City. AIDS Res Hum Retroviruses 2012; 28(3): 235-41. doi: 10.1089/aid.2011.0040 PMID: 21644847
  67. Nugmanova Z, Patel N, Akhmetova GM, et al. Relationship between vitamin D and human immunodeficiency virus (HIV) viral load among HIV-infected patients in Kazakhstan. J Infect Dev Ctries 2015; 9(11): 1277-83. doi: 10.3855/jidc.6808 PMID: 26623638
  68. Flauzino T, Simao ANC, de Almeida ERD, et al. Association between vitamin D status, oxidative stress biomarkers and viral load in Human Immunodeficiency Virus Type 1 infection. Curr HIV Res 2017; 15(5): 336-44. PMID: 28990534
  69. Lozano-Ros A, Martínez-Ginés ML, García-Domínguez JM, et al. Changes in the expression of TGF-beta regulatory pathway genes induced by vitamin D in patients with relapsing-remitting multiple sclerosis. Int J Mol Sci 2023; 24(19): 14447. doi: 10.3390/ijms241914447 PMID: 37833895
  70. Gunville C, Mourani P, Ginde A. The role of vitamin D in prevention and treatment of infection. Inflamm Allergy Drug Targets 2013; 12(4): 239-45. doi: 10.2174/18715281113129990046 PMID: 23782205
  71. Adams JS, Hewison M. Unexpected actions of vitamin D: New perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab 2008; 4(2): 80-90. doi: 10.1038/ncpendmet0716 PMID: 18212810
  72. Edfeldt K, Liu PT, Chun R, et al. T-cell cytokines differentially control human monocyte antimicrobial responses by regulating vitamin D metabolism. Proc Natl Acad Sci USA 2010; 107(52): 22593-8. doi: 10.1073/pnas.1011624108 PMID: 21149724
  73. Sudfeld CR, Giovannucci EL, Isanaka S, et al. Vitamin D status and incidence of pulmonary tuberculosis, opportunistic infections, and wasting among HIV-infected Tanzanian adults initiating antiretroviral therapy. J Infect Dis 2013; 207(3): 378-85. doi: 10.1093/infdis/jis693 PMID: 23162137
  74. Manion M, Hullsiek KH, Wilson EMP, et al. Vitamin D deficiency is associated with IL-6 levels and monocyte activation in HIV-infected persons. PLoS One 2017; 12(5): e0175517. doi: 10.1371/journal.pone.0175517 PMID: 28464004

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Declaração de direitos autorais © Bentham Science Publishers, 2024