Objectives: In the era of combination antiretroviral therapy (cART), vitamin D deficiency, low bone mineral density (BMD) and fractures have emerged as subjects of concern in HIV-positive patients. Testing for vitamin D deficiency has been widely adopted in clinical practice even though the benefits of vitamin D supplementation in this population remain uncertain. The objective of this review was to evaluate the evidence for such a strategy.
Design: Systematic review of the literature on vitamin D deficiency in HIV infection, the effects of cART on vitamin D status, and the effects of vitamin D deficiency and cART on parathyroid hormone (PTH), bone turnover, BMD and the incidence of fractures in HIV-positive patients.
Methods: PubMed was used to identify relevant articles up to September 2011.
Results: Vitamin D deficiency, secondary hyperparathyroidism and low BMD are common in HIV-positive patients. Efavirenz is associated with a reduction in 25-hydroxy vitamin D levels, tenofovir with secondary hyperparathyroidism, and cART with increased bone turnover and low BMD. The clinical significance of low BMD, however, remains unclear, especially in younger patients. Although the incidence of fractures may be increased in HIV-positive patients, the contribution of low BMD and vitamin D deficiency to these fractures is uncertain. Limited data on vitamin D supplementation in HIV-positive patients have shown transient, beneficial effects on PTH, but no effects on BMD.
Conclusion: The benefits of vitamin D supplementation in this population need to be demonstrated before widespread ‘test and treat’ policies can be recommended as part of routine clinical practice.
aKing's College Hospital
bBrighton and Sussex Medical School
cKing's College London School of Medicine, London, UK.
Correspondence to Dr Frank Post, King's College London School of Medicine, Weston Education Centre (2.53), Cutcombe Road, London SE5 9RJ, UK. Tel: +44 207 848 5779; fax: +44 207 848 5769; e-mail: firstname.lastname@example.org
Received 19 August, 2011
Revised 13 October, 2011
Accepted 14 November, 2011