Prevalence and risk factors for efavirenz-based antiretroviral treatment-associated severe vitamin D deficiency

• Verfasst von: Nylén, Hanna [VerfasserIn]
• Verfasst von: Habtewold, Abiy [VerfasserIn]
• Verfasst von: Makonnen, Eyasu [VerfasserIn]
• Verfasst von: Yimer, Getnet [VerfasserIn]
• Verfasst von: Bertilsson, Leif [VerfasserIn]
• Verfasst von: Burhenne, Jürgen [VerfasserIn]
• Verfasst von: Diczfalusy, Ulf [VerfasserIn]
• Verfasst von: Aklillu, Eleni [VerfasserIn]
• Titel: Prevalence and risk factors for efavirenz-based antiretroviral treatment-associated severe vitamin D deficiency
• Titelzusatz: a prospective cohort study
• Verf.angabe: Hanna Nylén, PhD, Abiy Habtewold, PhD, Eyasu Makonnen, PhD, Getnet Yimer, PhD, Leif Bertilsson, PhD, Jürgen Burhenne, PhD, Ulf Diczfalusy, PhD, Eleni Aklillu, PhD
• E-Jahr: 2016
• Jahr: 2016 Aug 26
• Fussnoten: Gesehen am 03.07.2020
• Titel Quelle: Enthalten in: Medicine
• Ort Quelle: Baltimore, Md. : Lippincott Williams & Wilkins, 1922
• Jahr Quelle: 2016
• Band/Heft Quelle: 95(2016,34) Artikel-Nummer e4631, 10 Seiten
• ISSN Quelle: 1536-5964
• DOI: doi:10.1097/MD.0000000000004631
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1703413687

Abstract

Initiation of efavirenz-based combination antiretroviral therapy (cART) is associated with Vitamin D deficiency, but the risk factors including efavirenz pharmacokinetics for cART-induced severe vitamin D deficiency (SVDD) and the impact of anti-tuberculosis (TB) cotreatment are not explored. We investigated the prevalence of SVDD in HIV and TB-HIV coinfected patients and associated risk factors for treatment-induced SVDD. - Treatment-naïve Ethiopian HIV patients with (n = 102) or without (n = 89) TB co-infection were enrolled prospectively and received efavirenz-based cART. In TB-HIV coinfected patients, rifampicin-based anti-TB treatment was initiated 4 or 8 weeks before starting cART. Plasma 25-hydroxyvitamin D (25 [OH]D), cholesterol and 4-beta hydroxycholesterol concentrations were measured at baseline, 4th, 16th, and 48th week of cART. Plasma efavirenz concentrations were determined at 4th and 16th weeks of cART. - TB-HIV patients had significantly lower plasma 25 (OH)D3 levels than HIV-only patients at baseline. TB co-infection, low Karnofsky score, high viral load, and high CYP3A activity as measured by plasma 4β-hydroxycholesterol/cholesterol ratios were significant predictors of low 25 (OH)D3 levels at baseline. In HIV-only patients, initiation of efavirenz-based cART increased the prevalence of SVVD from 27% at baseline to 76%, 79%, and 43% at 4th, 16th, and 48th weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by −40%, −50%, and −14% at 4th, 16th, and 48th weeks of cART, respectively. - In TB-HIV patients, previous anti-TB therapy had no influence on 25 (OH)D3 levels, but the initiation of efavirenz-based cART increased the prevalence of SVDD from 57% at baseline to 70% and 72% at the 4th and 16th weeks of cART, respectively. Median plasma 25 (OH)D3 declined from baseline by −17% and −21% at week 4 and 16 of cART, respectively. - Our results indicate low plasma cholesterol, high CYP3A activity, and high plasma efavirenz concentrations as significant predictors of early efavirenz-based cART-induced vitamin D deficiency. Low plasma 25 (OH)D3 level at baseline is associated with TB co-infection and HIV diseases progression. Initiation of efavirenz-based cART is associated with high incidence of SVDD, whereas rifampicin based anti-TB therapy co-treatment has no significant effect. Supplementary vitamin D during cART initiation may be beneficial for HIV patients regardless of TB coinfection.