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Effects of Anti-Retrovirus on Vitamin D Concentration in HIV Positive Patients

Introduction

After the reduction of opportunistic infections, other comorbidities implicating the central nervous system, cardiovascular, kidney, liver and bone have emerged and become increasingly significant in causing deaths during the cART (combination antiretroviral therapy) era. Vitamin D deficiency and low BMD (bone mineral density) are commonly found in HIV diagnosed patients and generally contribute to the experimental increased chances of bone fractures in the population. According to recent researches, vitamin D is affected by antiretroviral therapy. Other affected elements include risk of developing fractures, BMD, bone turnover and PTH (parathyroid hormone). As a result, Measurement of vitamin D and 25-hydroxy vitamin D replacement in low level situations has been adopted in clinical practice involving HIV. Nevertheless, evidence for cost effectiveness or benefit in clinical application is lacking for such a strategy. In this proposal, I will be reviewing the recent literature on vitamin D, effects of Antiretrovirals on concentration in the context of HIV patients. I will be analyzing the affects of cART on fractures, BMD, bone turnover and PTH levels in the context of HIV patients (Adeyemi et.al, p.57).

Literature Review

HIV Patients and Vitamin D Deficiency

Measurement of 25(OH) D should be used to assess the status of Vitamin D. Those patients with insufficiency of Vitamin D are identified through low levels of 25(OH) D [(20-30 ng/ml (50-75 nmol/l)], high deficiency [<10 ng/ml (<25 nmol/l)], and deficiency [10-20 ng/ml (25-50 nmol/)]. The range of vitamin D deficiency in HIV diagnosed people is from 29% to 74%. Nevertheless, vitamin D deficiency and HIV infection are not related per se. Very few researches have stated that HIV diagnosed people may have lower 25(OH) D levels. In fact, only one study has suggested this. Successive researches have suggested same or higher 25(OH) D levels, or similar or lower vitamin deficiency rates in patients diagnosed with HIV in comparison with the general population.

Following risk factors in HIV diagnosed patients, for low 25(OH) D levels, have been identified through cross-sectional studies to test the vitamin D deficiency in the general population (Bischoff-Ferrari et.al, p.1119). These risk factors include; low exercise level and hypertension, increased BMI, decreased ultraviolet exposure or measurements obtained in winter or fall season, Hispanic or black ethnicity. On the other hand, decreased odds of low status of vitamin D have been linked with lower estimated glomerular filtration. HIV parameters linked with lower 25(OH) D levels comprise a detectable or an undetectable level of HIV RNA, current use of cART, CD4 cell count less than 200 cells/ml, longer time since HIV diagnosis and use of intravenous drug. Although, the definition of clinical implications of deficiency of vitamin D in HIV diagnosed people is not provided, higher rates of death and AIDS have been tested in patients having 25(OH) D levels below 12 ng/ ml at baseline (Dao et.al, p.52).

Combination Antiretroviral Therapy and Vitamin D Deficiency

The impact of Anti-retrovirus on vitamin D concentration has received much attention in recent studies; the latest hypothesis states ...