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Tenofovir use is associated with low vitamin D levels in a Spanish HIV cohort

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Journal of the International AIDS Society201013 (Suppl 4) :P104

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  • Bone Mineral Density
  • Tenofovir
  • Efavirenz
  • Virologic Response
  • Abacavir


Several studies have shown a high frequency of vitamin D deficiency among HIV patients. Several studies have ascribed these low levels of vitamin D to antiretroviral treatment, especially efavirenz. Tenofovir has been related to changes of bone mineralization in SIV-infected rhesus monkeys and with loss of bone mineral density in children. Adequate vitamin D stores have the potential of an improvement of immune status, lessening of cardiovascular risk and beneficial effects on certain neoplastic disorders.


Cross-sectional study of 94 adult HIV outpatients in Leganés (Madrid, Spain) performed in 2008. Risk factors for vitamin D deficiency (< 20 µg/L) were examined using logistic regression.


Median age was 44 years (IQR 40 to 48); 69.1% were males, 93,6% whites, 6.4% black race. Mean CD4+ cell count was 446 cells/µL (IQR 312 to 586). Viral load was below 50 copies/mL in 78.7%. Median 25(OH)D level was 17.7 µg/L (IQR 11.9 TO 24.3). 87.2% of patients had 25(OH)D < 30 µg/L (suboptimal), 57.4% had 25(OH)D < 20 µg/L (deficient ) and 19.1% < 10 µg/L (severely deficient). Factors associated with low levels of 25(OH)D were heterosexual vs. IVDU HIV-risk group (OR 13.3, 95% CI 2.4-74.1, p=0.003), season (spring vs. summer; OR 16.8, 95% CI 3.4-82.1, p=0.0001), age >45 vs < 45 years (OR 10.5, 95% CI 2.4-46.6%, p=0.002), CD4+ cells nadir <200 vs >200 cells/µL (OR 4.1, 95% CI 1.01-17.6, p=0.049), and tenofovir vs. abacavir therapy (OR 12.7, 95% CI 1.8-87.1, p=0.01). Black race is underrepresented to draw conclusions. In this sample, no association of low 25(OH)D with efavirenz was found.


Despite low latitude, low levels of vitamin D are almost universal in our sample of HIV outpatients with satisfactory immunologic and virologic response to ART. Increasing age, less insolation season, heterosexual risk group, and CD4+ nadir were associated with lower levels. Tenofovir use was associated with lower levels of 25(OH)D. Further studies on causality of this association and the need of control bone-mineral density in tenofovir-treated patients seems warranted.

Authors’ Affiliations

H. Severo Ochoa, Internal Medicine. Infectious Disease Unit, Madrid, Spain
H. Severo Ochoa, Biochemist Service, Madrid, Spain
H. Severo Ochoa, Internal Medicine, Madrid, Spain
H. Severo Ochoa, Pharmacy Service, Madrid, Spain
H. Severo Ochoa, Hematology Service, Madrid, Spain
H. Severo Ochoa, Microbiology Service, Madrid, Spain


© Cervero et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.