Open AccessSecondary hyperparathyroidism in HIV‐infected patients: relationship with bone remodeling and response to vitamin D supplementation
Author(s) -
Bañon S,
Del Palacio M,
Pérez Elías M,
Moreno A,
Moreno S,
Dronda F,
Casado J
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18319
Subject(s) - medicine , parathyroid hormone , vitamin d and neurology , secondary hyperparathyroidism , bone remodeling , vitamin d deficiency , hyperparathyroidism , bone mineral , gastroenterology , regimen , prospective cohort study , endocrinology , osteoporosis , calcium
Purpose of the study Secondary hyperparathyroidism (SH) is frequent in HIV‐infected patients. However, the causes and consequences are not well established. The aim of our study was to determine the relationship between parathyroid hormone (PTH), vitamin D and bone mineral density (BMD) in HIV‐infected patients, and the effect of vitamin D replacement on PTH levels. Methods Prospective study of 506 patients with at least two sequential serum determinations of PTH and 25‐hydroxyvitamin D levels. In all cases, a bone dual X‐ray absorptiometry (DEXA) was performed at inclusion. Hyperparathyroidism was defined as a PTH level above 65 pg/ml. Summary of results Mean age was 44 yrs (24–78), and 75% were male. Mean BMI was 23.7 (17.97–33.11), and only 3% were of black race. Median nadir CD4+ was 200 cells/µL (9–499), and median time of HIV infection was 15.3 yrs (1.7–25.2). At inclusion, 488 patients (86%) were on HAART (31% TDF+PI, 44% TDF+NNRTI, 25% non‐TDF based regimen) for a median of 929.5 days (154–1969), and 40% were HCV‐coinfected. Median eGFR was 97.9 ml/min (62.14–134.08). Overall, mean serum PTH was 56.3 pg/mL (27.2–95.07). SH was observed in 27% of cases, with a marked influence of seasonality (from 44% in January to 10% in August). Mean levels of vitamin D were 17.45 ng/mL (7.6–40.78), with 16% below 10 ng/ml, 59%<20 ng/ml (deficiency), 85%<30 ng/ml (insufficiency). SH was related to vitamin D deficiency (relative risk, RR, 2.44), age (RR 1.04 per year), and a higher decrease in eGFR (RR 1.03 per ml/min), after adjustment by season, antiretroviral therapy, GFR at baseline, and HCV coinfection. DEXA scan showed 18% osteoporosis and 54% osteopenia, and there was an inverse correlation between PTH levels and T and Z score in femoral neck (r=−0.14, p<0.01), higher in those patients below 40 yrs. Vitamin D supplementation in 181 patients produced a significant decrease in serum PTH (57.2 if not treated vs 50.5 pg/ml, p=0.02, 23% continues with SH) and the only factor associated with lack of response was persistent vitamin D deficiency. Conclusion SH is relatively frequent in HIV patients, in close relation with vitamin D deficiency. It is associated with bone resorption, especially in the femoral neck. The use of vitamin D supplementation improves SH when levels above 20 ng/ml are achieved.