Bone health has become an increasingly important aspect of the care of HIV-infected patients as bone loss with antiretroviral therapy (ART) initiation is significant and osteopenia and osteoporosis are highly prevalent. Vitamin D is tightly linked to calcium balance and bone health, and vitamin D deficiency is common in HIV. This review outlines the epidemiology of vitamin D deficiency in HIV, summarizes our current understanding of the relationship between vitamin D and bone loss in HIV and the impact of vitamin D supplementation in this patient group.
Although data are conflicting as to whether vitamin D deficiency is more prevalent among HIV-infected individuals than in the general population, there are several reasons for why this patient group may be at heightened risk. Studies linking vitamin D deficiency to bone loss in HIV are limited; however, data from randomized clinical trials suggest a benefit of vitamin D supplementation for the prevention of bone loss with ART initiation and for the treatment of bone loss with bisphosphonate therapy.
There are too limited data to recommend universal screening of vitamin D status or supplementation to all HIV-infected individuals. However, testing 25-hydroxyvitamin D levels in those at risk for deficiency and treating patients found to be deficient or initiating ART or bisphosphonate therapy should be considered. Further study on vitamin D supplementation is needed regarding the potential benefit on immune activation and restoration in this patient group.
aDivision of Infectious Disease, MetroHealth Medical Center
bCase Western Reserve University School of Medicine, Cleveland, Ohio
cDivision of Infectious Disease, University of Alabama at Birmingham, Birmingham, Alabama
dDivision of Pediatric Infectious Disease and Rheumatology, Rainbow Babies and Children's Hospital and University Hospitals Case Medical Center, Cleveland, Ohio, USA
Correspondence to Grace A. McComsey, MD, Professor of Pediatrics and Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA. Tel: +1 216 844 3607; fax: +1 216 844 3926; e-mail: firstname.lastname@example.org