Vitamina D y VIH: Descripción y correlación de niveles séricos con variables clínicas y paraclínicas

Contenido principal del artículo

Cindy Paola De armas-Blanco
Heitmar Santiago Infante-Fernández
Zulma Dueñas
Carlos Pérez

Resumen

Introducción: La vitamina D (VD) tiene muchas funciones extra-esqueléticas (regulación inmune). Es importante reconocer su rol en pacientes infectados con el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio fue determinar las posibles correlaciones entre los niveles séricos de VD y múltiples variables clínicas, metabólicas y nutricionales en pacientes infectados por VIH. Materiales y métodos: Se realizó un estudio observacional, transversal en 161 pacientes infectados por VIH en la ciudad de Bogotá, Colombia. Los niveles de VD se analizaron con el perfil clínico, metabólico y nutricional. Resultados: Se encontró una prevalencia de hipovitaminosis D (<30 ng/ml) de 60,87%, con correlaciones estadísticamente significativas respecto al tiempo de exposición solar referido por el paciente y el tipo de terapia antirretroviral. Además, se encontró que el esquema de 2 inhibidores de transcriptasa reversa análogos de nucleósido + 1 inhibidor de integrasa se correlaciona con hipovitaminosis, incluso con tiempos de exposición solar adecuados. No hubo asociaciones con edad, sexo, raza, comorbilidades, perfil inmune, ni metabólico. Discusión: La deficiencia de VD es multifactorial, sin embargo, esta hipovitaminosis debe ser considerada dentro de los posibles efectos adversos de la terapia antirretroviral. Se sugiere incluir la medición de los niveles de VD en el seguimiento usual de estos pacientes.

Detalles del artículo

Sección
Articulos Originales

Citas

Ghosn J, Taiwo B, Seedat S, Autran B, Katlama C. HIV. Lancet. 2018 Aug 25;392(10148):685-697 Jul 23. PMID: 30049419.Epub 2018 https://doi.org/10.1016/S0140-6736(18)31311-4

Bbosa N, Kaleebu P, Ssemwanga D. HIV subtype diversity worldwide. Curr Opin HIV AIDS. 2019 May;14(3):153-160. PMID: 30882484. https://doi.org/10.1097/COH.0000000000000534

UNAIDS. Global HIV and AIDS statistics-2023 fact sheet [Online]; Available from: https://www.unaids.org/en/resources/fact-sheet.

Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers. 2015 Oct 1;1:15035. PMID: 27188527. https://doi.org/10.1038/nrdp.2015.35

Atta MG, De Seigneux S, Lucas GM. Clinical Pharmacology in HIV Therapy. Clin J Am Soc Nephrol. 2019 Mar 7;14(3):435-444. Epub 2018 May 29. PMID: 29844056; PMCID: PMC6419290. https://doi.org/10.2215/CJN.02240218

Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. Erratum in: Clin Infect Dis. 2021 Dec 08;: PMID: 33225349. https://doi.org/10.1093/cid/ciaa1391

Saponaro F, Saba A, Zucchi R. An Update on Vitamin D Metabolism. Int J Mol Sci. 2020 Sep 8;21(18):6573. PMID: 32911795; PMCID: PMC7554947. https://doi.org/10.3390/ijms21186573

Carlberg C, Muñoz A. An update on vitamin D signaling and cancer. Semin Cancer Biol. 2022 Feb;79:217-230. Epub 2020 May 30. PMID: 32485310. https://doi.org/10.1016/j.semcancer.2020.05.018

US Preventive Services Task Force; Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Epling JW Jr, Kubik M, Li L, Ogedegbe G, Owens DK, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Apr 13;325(14):1436-1442. PMID: 33847711. https://doi.org/10.1001/jama.2021.3069

Ryom L, De Miguel R, Cotter AG, Podlekareva D, Beguelin C, Waalewijn H, Arribas JR, Mallon PWG, Marzolini C, Kirk O, Bamford A, Rauch A, Molina JM, Kowalska JD, Guaraldi G, Winston A, Boesecke C, Cinque P, Welch S, Collins S, Behrens GMN; EACS Governing Board. Major revision versión 11.0 of the European AIDS Clinical Society Guidelines 2021. HIV Med. 2022 Sep;23(8):849-858. Epub 2022 Mar 25. PMID: 35338549; PMCID: PMC9545286. https://doi.org/10.1111/hiv.13268

Hsieh E, Yin MT. Continued Interest and Controversy: Vitamin D in HIV. Curr HIV/AIDS Rep. 2018 Jun;15(3):199-211. PMID: 29713871; PMCID: PMC6003869. https://doi.org/10.1007/s11904-018-0401-4

Ahmed M, Mital D, Abubaker NE, Panourgia M, Owles H, Papadaki I, Ahmed MH. Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies. Microorganisms. 2023 Mar 19;11(3):789. PMID: 36985362; PMCID: PMC10052733. https://doi.org/10.3390/microorganisms11030789

Giustina A, Adler RA, Binkley N, Bouillon R, Ebeling PR, Lazaretti-Castro M, Marcocci C, Rizzoli R, Sempos CT, Bilezikian JP. Controversies in Vitamin D: Summary Statement From an International Conference. J Clin Endocrinol Metab. 2019 Feb 1;104(2):234-240. PMID: 30383226. https://doi.org/10.1210/jc.2018-01414

Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection--United States, 2014. MMWR Recomm Rep. 2014 Apr 11;63(RR-03):1-10. PMID: 24717910.

Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981 Nov;34(11):2540-5. PMID: 6975564. https://doi.org/10.1093/ajcn/34.11.2540

Burt VL, Harris T. The third National Health and Nutrition Examination Survey: contributing data on aging and health. Gerontologist. 1994 Aug;34(4):486-90. PMID: 7959106. https://doi.org/10.1093/geront/34.4.486

Ismailova A, White JH. Vitamin D, infections and immunity. Rev Endocr Metab Disord. 2022 Apr;23(2):265-277. Epub 2021 Jul 29. PMID: 34322844; PMCID: PMC8318777. https://doi.org/10.1007/s11154-021-09679-5

Netto EC, Silva AC, Pedroso C, Brites C. Hypovitaminosis D Is Associated with Higher Levels of Inflammatory Cytokines and with HAM/TSP in HTLV-Infected Patients. Viruses. 2021 Nov 4;13(11):2223. Erratum in: Viruses. 2022 Jul 26;14(8): PMID: 34835029; PMCID: PMC8623239. https://doi.org/10.3390/v13112223

Qurban R, Saeed S, Kanwal W, Junaid K, Rehman A. Potential immune modulatory effect of vitamin D in HIV infection: A review. Clin Nutr ESPEN. 2022 Feb;47:1-8. Epub 2021 Dec 6. PMID: 35063189. https://doi.org/10.1016/j.clnesp.2021.12.005

Kanwal W, Rehman A. High prevalence of vitamin D deficiency in HIV infected individuals in comparison with the general population across Punjab province, Pakistan. Saudi J Biol Sci. 2023 Jan;30(1):103484. Epub 2022 Oct 31. PMID: 36387030; PMCID: PMC9649934. https://doi.org/10.1016/j.sjbs.2022.103484

Knuschke P. Sun Exposure and Vitamin D. Curr Probl Dermatol. 2021;55:296-315. Epub 2021 Oct 25. PMID: 34698034. https://doi.org/10.1159/000517640

Wang Y., Huang X., Wu Y., Li A., Tian Y., Ren M., Li Z., Zhang T., Wu H., Wang W. Increased Risk of Vitamin D Deficiency Among HIV-Infected Individuals: A Systematic Review and Meta-Analysis. Front. Nutr. 2021;8:722032. https://doi.org/10.3389/fnut.2021.722032

Brown TT, McComsey GA. Association between initiation of antiretroviral therapy with efavirenz and decreases in 25-hydroxyvitamin D. Antivir Ther. 2010;15(3):425-9. PMID: 20516561. https://doi.org/10.3851/IMP1502

Wang PF, Neiner A, Kharasch ED. Efavirenz Metabolism: Influence of Polymorphic CYP2B6 Variants and Stereochemistry. Drug Metab Dispos. 2019 Oct;47(10):1195-1205. Epub 2019 Jul 19. Erratum in: Drug Metab Dispos. 2019 Oct;47(10):1231. PMID: 31324697; PMCID: PMC6756292.https://doi.org/10.1124/dmd.119.086348

Lu CH, Bednarczyk EM, Catanzaro LM, Shon A, Xu JC, Ma Q. Pharmacokinetic drug interactions of integrase strand transfer inhibitors. Curr Res Pharmacol Drug Discov. 2021 Aug 8;2:100044. PMID: 34909672; PMCID: PMC8663927. https://doi.org/10.1016/j.crphar.2021.100044

Kajogoo VD, Gorret Atim M, Amare D, Geleta M, Muchie Y, Tesfahunei HA, Olomi W, Acam J, Manyazewal T. HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol. 2021 Nov 1;12:635089. PMID: 34790115; PMCID: PMC8591121. https://doi.org/10.3389/fphar.2021.635089