Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic.

– Hypovitaminosis D is a very common disorder, regarding both Western and developing countries. A growing amount of data over the last years have shown vitamin D deficiency to be high prevalent among HIV-positive subjects. In addition to “classic” risk factors, such as female sex, low dietary intake, dark skin pigmentation and low sun exposure, HIV-related factors, including immune activation and antiretroviral adverse effects, may affect vitamin D status. Even if both protease inhibitors and nonnucleoside reverse transcriptase inhibitors have been associated with low vitamin D levels, available evidences have failed to univocally associate hypovitaminosis D with specific antiretroviral class effects. Low vitamin D is known to have a negative impact not only on bone health, but also on neurocognitive, metabolic, cardiovascular and immune functions. Similarly to the general population, several studies conducted on HIV-infected subjects have associated hypovitaminosis D with a greater risk of developing osteopenia/osteoporosis and fragility fractures. Analogously, vitamin D deficiency has been described as an independent risk factor for cardiovascular disease and metabolic disorders, such as insulin resistance and type 2 diabetes mellitus. Last EACS guidelines suggest to screen for hypovitaminosis D every HIV-positive subject having a history of bone disease, chronic kidney disease or other known risk factors for vitamin D deficiency. Vitamin D repletion is recommended when 25-hydroxyvitamin D levels are below 10 ng/ml. Furthermore, it may be indicated in presence of 25OHD values between 10 and 30 ng/ml, if associated with osteoporosis, osteomalacia or Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic M.R. PINZONE1, M. DI ROSA1, M. MALAGUARNERA2, G. MADEDDU3, E. FOCÀ4, G. CECCARELLI 5, G. D’ETTORRE5, V. VULLO5, R. FISICHELLA6, B. CACOPARDO1, G. NUNNARI 1,7 1Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Italy 2International PhD Programme in Neuropharmacology, University of Catania, Italy 3Department of Clinical, Experimental and Oncological Medicine, Division of Infectious Diseases, University of Sassari, Italy 4University Division of Infectious Diseases, University of Brescia, Brescia, Italy 5Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Rome, Italy 6Department of Surgery University of Catania, Catania, Italy 7Department of Microbiology and Immunology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA Corresponding Author: Giuseppe Nunnari, MD; e-mail: gnunnari@hotmail.com increased parathyroid hormone levels. The optimal repletion and maintenance dosing regimens remain to be established, as well as the impact of vitamin D supplementation in preventing comorbidities.