Higher vitamin D levels in HIV ‐infected out‐patients on treatment with boosted protease inhibitor monotherapy

Objectives We investigated the vitamin D status of patients receiving frequently used types of combination antiretroviral therapy ( cART ), including boosted protease inhibitor ( PI ) monotherapy. Methods For this cross‐sectional study, out of 450 HIV ‐infected patients followed in the H ospital S evero O choa ( M adrid, S pain), we selected 352 patients for whom vitamin D levels had been measured ( J anuary 2009 to D ecember 2010). We collected the following data: demographics, cART duration, main cART regimen, viral load ( VL ), CD 4 cell count, and concentrations of 25( OH )‐vitamin D [25( OH )‐ D ], parathyroid hormone ( PTH ), albumin and calcium. Vitamin D status cut‐off points were: (1) deficiency ( vitDd ): 25( OH )‐ D < 20 ng/mL; (2) insufficiency ( vitDi ): 25( OH )‐ D from 20 to 29.99 ng/mL; and (3) optimal ( vitDo ): 25( OH )‐ D ≥ 30 ng/mL. Results The percentages of patients with vitDd , vitDi and vitDo were 44, 27.6 and 28.5%, respectively. Twenty‐nine out of 30 (96.7%) Black patients had vitDd or vitDi , vs. 71.6% in the global sample ( P  < 0.001). Former injecting drug users ( IDUs ) had a higher prevalence of vitDo ( P  < 0.001) than patients in other transmission categories. Among patients with vitDd, vitDi and vitDo, the proportions of patients with a VL ≤ 50 HIV‐1 RNA copies/mL were 77.4, 68 and 91%, respectively ( P  < 0.0001). Of the cART regimens, only boosted PI monotherapy was associated with significant differences in vitamin D levels ( P  = 0.039). Multivariate logistic regression analysis showed an increased risk of vitDi or vitDd associated with the following variables: Black vs.   C aucasian ethnicity [odds ratio ( OR ) 10.6; 95% confidence interval ( CI ) 1.2–94; P  = 0.033]; heterosexual ( OR 2.37; 95% CI 1.13–4.93; P  = 0.022) or men who have sex with men ( MSM ) ( OR 3.25; 95% CI 1.25–8.50; P  = 0.016) transmission category vs. former IDU ; and VL > 50 copies/mL ( OR 2.56; 95% CI 1.10–7.25; P  = 0.040). A lower risk of vitamin D insufficiency or deficiency was found in patients on boosted PI monotherapy vs. no treatment ( OR 0.08; 95% CI 0.01–0.6; P  = 0.018). Conclusions Our data show an increased risk of vitamin D deficiency or insufficiency in patients with detectable VL and a Black ethnic background. Among cART regimens, boosted PI monotherapy was associated with a lower risk of vitamin D deficiency or insufficiency. The more favourable vitamin D status in former IDUs was probably attributable to a higher frequency of outdoor jobs in this group of patients.