Date

6-2015

Document Type

Thesis

Degree Name

M.S.

Institution

Oregon Health & Science University

Abstract

Vitamin D deficiency may be common among HIV infected individuals. Similar to individuals not affected by HIV, HIV-infected patients are affected by limited UV-B exposure and vitamin D deficient diet. However, HIV-infected patients may be at increased risk for insufficient vitamin D due to antiretroviral medication regimens that affect vitamin D metabolism and fat malabsorption due to HIV-related inflammation. In this historical chart review, we examined the prevalence of vitamin D insufficiency and assessed the comparative effectiveness of varying vitamin D repletion regimens in an HIV-infected cohort. The study population comprised patients from an outpatient HIV clinic who had vitamin D measured and who were prescribed a vitamin D repletion regimen. Demographic and clinical data were extracted from medical records, including 25-(OH)D concentrations drawn at baseline and follow-up appointments. Specific factors were analyzed in association with the main outcome of change in serum 25-(OH)D, including season of blood draw and body mass index. Differences in the change in 25-(OH)D between regimens were calculated by one-way ANOVA. A total of 228 subjects were studied. There was a high prevalence of 25-(OH)D insufficiency (/mL; 71.4%, 160/224). Vitamin D supplementation reduced this prevalence by 10.2% after an average of 14.0 ± 6.3 months (range: 0.7 – 49.0 months). A significant difference in change in 25-(OH)D concentration among vitamin D regimens was noted between the repletion/maintenance regimen (50,000 IU D2 weekly/400-5,000 D2 or D3 IU daily) and the single vitamin D3 (chole-) based regimens (adjusted p-value = 0.047). Interestingly, when grouped by dosage strength no significant differences in change in serum 25-(OH)D were noted (adjusted p-value = 0.489). When patients were grouped into respective BMI categories of underweight/normal weight (BMI: 16-24 kg/m2), overweight (BMI: 25-29 kg/m2), and obese (BMI: 30-45 kg/m2), no overall difference was noted among patients’ change in serum 25-(OH)D (p-value = 0.10). Though vitamin D deficiency and insufficiency were both prevalent at baseline and follow-up appointments, there was a significant difference between vitamin D regimens in patients’ change of serum 25-(OH)D (adjusted p-value: 0.04). However, no significant differences were noted when average change in serum 25-(OH)D was grouped by dosage strengths (adjusted p-value: 0.489). This research highlights the complexity of increasing vitamin D serum status in an HIV-infected population. Since patient adherence to vitamin D supplementation was not measured in this historical chart review, we were unable to witness any alteration to vitamin D metabolism from an interaction of ARV medications. ARV medication can mimic low adherence rates to vitamin D supplementation as both result in reduced 25-(OH)D change. Given what is currently known about vitamin D and immune health, further interventional studies assessing the effects of 25-(OH)D supplementation in HIV-infected patients are needed. Future research should investigate the effects not only of different vitamin D doses but also of vitamin D types in raising serum 25-(OH)D status.

Identifier

doi:10.6083/M4R49PHF

Division

Graduate Programs in Human Nutrition

School

School of Medicine

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