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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31824a0d1d
Letters to the Editor

Vitamin D Deficiency in HIV-Infected and -Uninfected Women in the United States

Chotalia, Jigar MD, MPH*; Frontini, Maria DVM, PhD; Tatini, Priyanka BDS*; Nsuami, M. Jacques MD, MPH; Martin, David H. MD; Clark, Rebecca A. MD, PhD

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*Epidemiology Department, Louisiana State University School of Public Health, New Orleans, LA

Medicine Department, Louisiana State University Health Science Center, New Orleans, LA

The authors have no funding or conflicts of interest to disclose.

To the Editors:

We read the article by Adeyemi et al with interest1 because we had recently conducted similar analyses at our site using data from an HIV+ cohort followed at the HIV Outpatient Program based at the Interim Louisiana State Hospital and an HIV− population of women who were evaluated at 2 sexually transmitted disease clinics, one of each located in the states of Louisiana and Mississippi. Data on 90 HIV+ and 286 HIV− women were collected between October 2006 and December 2010. The data from HIV− women were limited to vitamin D levels, race, and age, but several additional variables of interest were available on HIV+ women.

HIV+ women were significantly older than HIV− women (mean age = 49.1 years ± 11.9, median = 49 years vs. 27.8 years ± 4.71, median = 27 years; P < 0.0001), but the 2 groups were racially similar (94.4% African American in HIV− vs. 93.3% African American in HIV+; P = 0.8). In our analysis, 263 of 376 (69.9%) women had vitamin D levels <20 ng/mL. The proportions of HIV+ (63 of 90, 70.0%) and HIV− women (200 of 286, 69.9%) with vitamin D levels <20 ng/mL were the same. In combined study population (HIV+ and HIV− women), the proportion of African American women with vitamin D levels <20 ng/mL was significantly higher than non African American women (71.7% vs. 40.9%, P = 0.002). Among women with vitamin D <20 ng/mL, 81.4% were under 40 years of age, 8.7% were between 40 and 50 years, and 9.9% were older than 50 years of age. African American race [adjusted odds ratio (OR) = 3.81, 95% confidence interval (CI) = 1.57 to 9.22; P = 0.003] remained significantly associated with vitamin D levels <20 ng/mL in a logistic regression analysis controlling for age (adjusted OR = 0.97, 95% CI = 0.94 to 1.01; P = 0.12) and HIV status (adjusted OR = 1.78, 95% CI = 0.73 to 4.35; P = 0.20).

In logistic regression analyses confined to HIV+ women, body mass index (BMI) <18.5 kg/m2 (adjusted OR = 0.03, 95% CI = 0.001 to 0.67; P = 0.03) and previous vitamin D supplementation (adjusted OR = 0.22, 95% CI = 0.06 to 0.81; P = 0.02) significantly predicted vitamin D levels >20 ng/mL,whereas CD4 count <500 cells per cubic millimeter significantly predicted vitamin D levels <20 ng/mL (adjusted OR = 3.60, 95% CI = 1.03 to 12.56; P = 0.04). Tenofovir use (adjusted OR = 3.69, 95% CI = 0.97 to 14.08; P = 0.06) weakly predicted vitamin D levels <20 ng/mL.

Our results are consistent with those found by Adeyemi et al.1 The prevalence of vitamin D deficiency (vitamin D levels <20 ng/mL) among HIV− women were similar (70.0% in our study and 71.8% in the Women's Interagency HIV Study [WIHS]), and among HIV+ women, the prevalence of vitamin D deficiency in our study (70%) and in the WIHS cohort (60%) were within the 45%–87% range reported in several studies of vitamin D levels among individuals infected with HIV.2–4 In the study by Adeyemi et al1 and in our study, African American race and high BMI were significant predictors of vitamin D deficiency. These findings were not unexpected because African American race2–4 and high BMI5,6 have been shown to be risk factors for vitamin D deficiency in the general population.7,8 Among HIV+ women, lower CD4 count remained an independent significant predictor of vitamin D deficiency in the WIHS and our cohorts. HIV infection in our study was not a significant predictor of vitamin D levels. This was also consistent with the lack of independent significant association of HIV infection with vitamin D levels in the WIHS cohort when vitamin D was modeled as a continuous variable.1 The findings from the WIHS cohort of significant associations of geographic locations with vitamin D deficiency1 suggest that additional studies from other geographic areas with diverse populations are warranted to evaluate predictors for low vitamin D levels both in the general population and among HIV+ individuals.

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1. Adeyemi OM, Agniel D, French AL, et al.. Vitamin D deficiency in HIV-infected and HIV-uninfected women in the United States. J Acquir Immune Defic Syndr. 2011;57:197–204.

2. Van Den Bout-Van Den Beukel CD, Fievez L, Michels M, et al.. Vitamin D deficiency among HIV type 1-infected individuals in the Netherlands: effects of antiretroviral therapy. AIDS Res Hum Retroviruses. 2008;24:1375–1382.

3. Rodriguez M, et al.. High frequency of vitamin D deficiency in ambulatory HIV-Positive patients. AIDS Res Hum Retroviruses. 2009;25:9–14.

4. Dao CN, et al.. Low vitamin D among HIV-infected adults: prevalence of and risk factors for low vitamin D Levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clin Infect Dis. 2011;52:396–405.

5. Wortsman J, et al.. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–693.

6. Freedman BI, et al.. Vitamin d, adiposity, and calcified atherosclerotic plaque in african-americans. J Clin Endocrinol Metab. 2010;95:1076–1083.

7. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281.

8. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87:1080S–1086S.

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