Rustin D. Crutchley*, David M. Jacobs, Joseph Gathe, Carl Mayberry, Nataliya Bulayeva, Kevin P. Rosenblatt and Kevin W. Garey Pages 61 - 72 ( 12 )
Background: Vitamin D deficiency is common in HIV population and has been associated with increased comorbidity risk and poor immunologic status.
Objective: To evaluate the effect of protease inhibitor lopinavir/ritonavir monotherapy on changes in serum 25-hydroxyvitamin D [25(OH)D] over 48 weeks.
Methods: Thirty-four treatment-naïve HIV individuals initiating lopinavir/ritonavir monotherapy and receiving clinical care from private practice in Houston, Texas, were included. Serum 25-hydroxyvitamin D levels from stored plasma samples collected from IMANI-2 pilot study at both baseline and 48 weeks were analyzed using LC-MS assays. Mean 25(OH)D at baseline and 48 weeks were compared using paired t-tests. Linear regression analysis was used to evaluate factors associated with changes in 25(OH)D. Logistic regression analyses were used to determine the effect of vitamin D status and covariates on CD4 cell count recovery.
Results: Mean 25(OH)D was significantly higher at 48 weeks (26.3 ng/mL (SD + 14.9); p=0.0003) compared to baseline (19.8 ng/mL (SD +12.1), with fewer individuals having vitamin D deficiency (41.2%) and severe deficiency (11.8%). Both body mass index and baseline CD4 cell count were significant independent covariates associated with 25(OH)D changes over 48 weeks. Baseline vitamin D status did not affect CD4 cell count recovery. However, in a 24-week multivariate analysis, current tobacco use was significantly associated with a decreased odds of CD4 cell count recovery (AOR 0.106, 95% CI 0.018-0.606; p=0.012).
Conclusion: Individuals treated with lopinavir/ritonavir monotherapy had significantly higher 25(OH)D after 48 weeks. Current tobacco users had significantly diminished CD4 cell count recovery after starting treatment, warranting further clinical investigation.
Vitamin D, lopinavir/ritonavir monotherapy, HIV, tobacco, CD4, body mass index.
Department of Pharmacotherapy, Washington State University, College of Pharmacy and Pharmaceutical Sciences, Yakima, WA, Department of Pharmacy Practice, University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, Therapeutic Concepts, Inc, Houston, TX, Therapeutic Concepts, Inc, Houston, TX, University of Texas Health Science Center at Houston, Houston, TX, University of Texas Health Science Center at Houston, Houston, TX, Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Houston, TX