Vani Gandhi, MDAttending Physician

Center for Comprehensive Care Director of Integrative Medicine

St. Luke’s-Roosevelt Hospital Center

Evaluation of Vitamin D levels in HIV-infected patients at the Center for Comprehensive Care, St. Luke’s-Roosevelt Hospital Center. New York. USA

Oral Poster discussion Shining Light on Vitamin D deficiency

V. Gandhi, JH Kim, G. Psevdos, F. Espinoza, J. Park, V. Sharp

Introduction Vitamin D (VitD) is an essential vitamin obtained

through food and sunlight exposure. 1-25-dihydroxyvitamin D controls more than 200

genes, including genes responsible for the regulation of cellular proliferation, differentiation, apoptosis and angiogenesis.

Role in decreasing the risk of many chronic illnesses, including bone disorders, common cancers, autoimmune disorders, infectious and cardiovascular diseases.

All mentioned conditions are increasingly observed in HIV-infected patients.

Few studies have examined the VitD status in HIV-infected patients.

Materials and Methods A retrospective chart review of 2992 HIV-infected

patients. Conducted from 9/1/08 to 5/31/09 342 patients had 25-hydroxyvitamin D level

obtained Deficiency: Level <20 ng/mL Insufficiency: Level 21-29 ng/mL Optimum level: Level 30-80 ng/mL RESULTS:

• VitD <20: 205/342 (59.9%) • VitD 21-29: 86/342 (25.1%) and• VitD 30-66: 51/342 (14.9%)

Results Comparing the deficient and insufficient group

(291 patients) with the normal (51 patients), there were no differences in age (P: 0.386), sex (P: 0.550), Caucasian or Hispanic race, CD4 (P: 0.255), HIV viral load (P: 0.277), exposure to tenofovir (P: 0.831), albumin (P:0.846), and body mass index (BMI) (P: 0.155).

There was a difference, however, in African American race (P:0.027), and calcium levels (P:0.011). A logistic regression analysis for predictors of VitD level <20 found African American Race (OR: 2.615 95% CI:1.404 – 4.871), calcium level <8.5 (OR: 14.580 95% CI: 1.464 – 145.184) and BMI ≥ 18.5 (OR: 5.766 (1.236 – 26.904) to be associated with VitD deficiency.

Discussion 1,25-dihydroxyvitamin D is a potent immunomodulator. Very few studies have examined VitD levels in HIV

infected patients on antiretroviral therapy (ART) and these studies did not find a correlation between VitD status and CD4 cell recovery after initiation of ART.

Few studies have shown that low VitD levels may be associated with HIV disease progression in the absence of ART.

HIV infected patients have an increased risk for other infectious diseases, like common cold, influenza, pneumonia, tuberculosis and there is evidence that VitD deficiency is another predisposing factor to acquire such infections.

Van Den Bout-Van Den Beukel C, Fievez L, Michels M et al. Vitamin D deficiency among HIV type 1-infected individuals in the Netherlands effects of antiretroviral therapy. AIDS Res. Hum. Retroviruses 2008. 24:1375-1382.

Ginde AA, Mansbach JM, Camargo CA Jr. Vitamin D, respiratory infections, and asthma. Curr Allergy Asthma Rep. 2009 Jan;9(1):81-7.

Conclusion VitD deficiency (<20 ng/mL) was noted in 205/342

(59.9%) of HIV-infected patients. Prevalent in our patients during the months with

decreased sun exposure in the Northeastern United States.

African Americans more likely to be VitD deficient which was expected.

Consider checking VitD levels in all HIV-infected patients.

Consider further studies to evaluate association between VitD deficiency and malignancies, infectious diseases and cardiovascular diseases in HIV-infected patients.

Holick Michael. Vitamin D deficiency. N Eng J Med 2007:357:266-81. Mehta S, Giovannucci E, Mugusi F et al. Vitamin D status of HIV-infected women and its

association with HIV disease progression, anemia and mortality. Plos One 2010. 5(1):e8770. Tseng M, Giri V, Bruner DW, Giovannucci E. Prevalence and correlates of vitamin D status in

African American men. BMC Public Health. 2009 Jun 18;9:191.