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

Hypovitaminosis D is a very common disorder, regarding both Western anddeveloping countries. A growing amount of data over the last years have shownvitamin D deficiency to be high prevalent among HIV-positive subjects. Inaddition to "classic" risk factors, such as female sex, low dietary intake, dark skin pigmentation and low sun exposure, HIV-related factors, including immuneactivation and antiretroviral adverse effects, may affect vitamin D status. Even if both protease inhibitors and non-nucleoside reverse transcriptase inhibitorshave been associated with low vitamin D levels, available evidences have failedto univocally associate hypovitaminosis D with specific antiretroviral classeffects. Low vitamin D is known to have a negative impact not only on bonehealth, but also on neurocognitive, metabolic, cardiovascular and immunefunctions. Similarly to the general population, several studies conducted onHIV-infected subjects have associated hypovitaminosis D with a greater risk ofdeveloping 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 diabetesmellitus. Last EACS guidelines suggest to screen for hypovitaminosis D everyHIV-positive subject having a history of bone disease, chronic kidney disease or other known risk factors for vitamin D deficiency. Vitamin D repletion isrecommended when 25-hydroxyvitamin D levels are below 10 ng/ml. Furthermore, itmay be indicated in presence of 25OHD values between 10 and 30 ng/ml, ifassociated with osteoporosis, osteomalacia or increased parathyroid hormonelevels. The optimal repletion and maintenance dosing regimens remain to beestablished, as well as the impact of vitamin D supplementation in preventingcomorbidities.