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Vitamin D deficiency and its relation to bone mineral density and liver fibrosis in HIV–HCV coinfection

Diala El-Maouche, Shruti H Mehta, Catherine G Sutcliffe, Yvonne Higgins, Michael S Torbenson, Richard D Moore, David L Thomas, Mark S Sulkowski, Todd T Brown

Corresponding author name: Todd T Brown
Corresponding author e-mail: tbrown27@jhmi.edu

Citation: Antiviral Therapy 2013; 18:237-242
doi: 10.3851/IMP2264

Date accepted: 22 May 2012
Date published online: 07 August 2012

Abstract

Background: Fractures and cirrhosis are major causes of morbidity and mortality among HIV–HCV-coinfected individuals. It is not known whether vitamin D deficiency is associated with these outcomes.

Methods: Between 2005 and 2007, 116 HIV–HCV-coinfected individuals underwent dual-energy X-ray absorptiometry within 1 year of a liver biopsy. 25-Hydroxyvitamin D (25OHD) and parathyroid hormone were measured from archived samples. Low bone mineral density (BMD) was defined as BMD≥2 standard deviations lower than age-, sex- and race-matched controls (Z-score ≤-2.0) at the total hip, femoral neck or lumbar spine. Histological fibrosis staging was assessed according to the METAVIR system (0 [no fibrosis] to 4 [cirrhosis]).

Results: The cohort was 87% African-American and 63% male. The median age (IQR) was 49.9 years (46.5–53.3). A total of 89% had a CD4+ T-cell count >200 cells/mm3 and 64% were receiving HAART. The median 25OHD was 19 ng/ml (IQR 11.0–26.0). Hypovitaminosis D (25OHD≤15 ng/ml) was present in 41% and secondary hyperparathyroidism, defined by parathyroid hormone >65 pg/ml, was present in 24%. In total, 27% had low BMD (Z-score ≤-2) at the spine, femoral neck or total hip, and 39% had significant hepatic fibrosis (METAVIR≥2). In multivariate analysis, vitamin D deficiency was not associated with significant fibrosis or with BMD at any site.

Conclusions: Vitamin D deficiency was highly prevalent in this mostly African-American HIV–HCV-coinfected population, but was not related to BMD or liver disease severity. These data suggest that efforts to increase vitamin D levels in this population may not improve bone or liver outcomes.

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