Vitamin D and Secondary Hyperparathyroidism in HIV Infected Patients Taking Antiretroviral Therapy

Huylmer Lucena Chaves¹, Henrique Pires Moreira¹, Hayato Augusto Hossoé Corrêa¹, William Browne de Oliveira Machado¹, Rian Brito Teles¹, Lucigleyson Ribeiro do Nascimento¹, Janedson Baima Bezerra Filho¹, Camilla Camuza Coelho Rabelo Queiroz¹, Danilo Gonçalves Nóbrega¹, Ana Carolina Vasconcelos Moreira¹, Maria Carolina Nunes Albano de Meneses¹, Fabrício de Maicy Bezerra^1,2,3, Melissa Soares Medeiros^1,2,3

¹Medicine School, UNICHRISTUS, Fortaleza, Brazil.
²Fortaleza General Hospital, Fortaleza, Brazil.
³Sao Jose Hospital of Infectious Diseases, Fortaleza, Brazil.

DOI: 10.4236/wja.2014.44051                

Abstract

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 < 500 cels/mm³ (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.

Keywords

HIV, Hyperparathyroidism, Vitamin D, Antiretroviral Therapy

Conflicts of Interest

The authors declare no conflicts of interest.

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