Vitamin D and Secondary Hyperparathyroidism in HIV Infected Patients Taking Antiretroviral Therapy
2014
Objective: Due to the lack
of studies assessing hypovitaminosis D and secondary hyperparathyroidism in
Brazilian HIV-infected population, especially in the northeastern population,
this study aimed to determine the profile of these conditions in patients
infected with HIV and its correlation with immuno-virological, sociodemographic
data and associated comorbidities. Methods: Comparison studies were obtained
from routine clinical samples of HIV infected patients submitted for 25-OH
Vitamin D, PTH and alkaline phosphatase determination. Results: A total of 78
patients were included, 42 (53.8%) males, mean age 45.7 years. Antiretroviral
regimens most used in this study
were Zidovudine/Lamivudine/Efavirenz 17.9%, Tenofovir/Lamivudine/Efavirenz
17.9%,Tenofovir/Lamivudine/Atazanavir-r 15.4%. The mean value CD4 count was
592.1 ± 247.2 cells/mm3, CD8
cell count was 1026.5 ± 467.3 cells/mm3, mean detectable viral load
was 2220 ± 15703 copies and CD4/CD8 ratio was 0.63 ± 0.33.
A total of 34 vitamin D dosages were collected with 41.2% representing
sufficient amount and 58.8% insufficient. Alkaline Phosphatase (ALP) dosage was
elevated in 49.3% (N=35) of the patients. Parathormone (PTH) was elevated in
18% (N = 11). Among patients with elevated PTH levels, 81.9% had elevated
levels of ALP (p = 0.01). In the group of patients with high levels of ALP,
45.7% had a CD4 count 3 (p = 0.02). There was no significant
difference in vitamin D related to gender (p = 0.21), age (p = 0.23), CD4 count
(p = 0.26), suppressed viral load (p = 0.44) or blood glucose (p = 0.45).
Conclusions: This study evidenced a high prevalence of Vitamin D insufficiency
in Northeast Brazil, which suggests HIV infection correlation. A high
prevalence of Hyperparathyroidism was detected and related with inflammatory
condition persistence and low CD4 count. We suggest improve vitamin D follow up
and measurements in this population with better CD4 count control to avoid
future osteoarticular complications of HIV treatment.
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