Vitamin D insufficiency is associated with subclinical atherosclerosis in HIV-1-infected patients on combination antiretroviral therapy

Abstract

Objectives: Vitamin D insufficiency has been associated with faster progression of atherosclerosis and increased cardiovascular disease risk, but limited data are available in HIV-infected people. So, we examined potential correlation between vitamin D status and atherosclerosis in people living with HIV.

Methods: A cross-sectional study was performed including adult HIV-infected patients on stable antiretroviral therapy, aged 40–60 years, and with a recent carotid ultrasonography. Subclinical atherosclerosis was defined as a carotid intima-media thickness (IMT) ≥0.9 mm at any site. Patients with diabetes mellitus or atherosclerotic cardiovascular disease were excluded.

Results: On the whole, 188 patients were enrolled: 86.2% were men and the mean age was 49.1 years. The mean CD4 T lymphocyte count was 567 cells/mm³, 176 (93.6%) had plasma HIV RNA <20 copies/mL, 51.1% were smoker, 29.2% had hypertension, 27.7% metabolic syndrome, and 44.7% LDL cholesterol >150 mg/dL. The mean serum concentration of vitamin D was 35.2 ng/mL, and 84 (44.6%) patients had a vitamin D insufficiency (<30 ng/mL). Subclinical atherosclerosis was reported in 105 (55.8%) and the mean vitamin D concentration was significantly lower among patients with subclinical atherosclerosis than among those without (18.2 vs 41.3 ng/mL, p < 0.001). Moreover, the multivariate linear regression analysis adjusted by confounding factors showed an independent association between subclinical atherosclerosis and vitamin D insufficiency, age >50 years, smoking, hypertension, metabolic syndrome, higher BMI, higher LDL cholesterol, longer duration of HIV infection, lower nadir CD4 cell count, and longer exposure to boosted protease inhibitors.

Conclusion: In our study, vitamin D insufficiency is significantly associated with subclinical atherosclerosis, so its role in HIV-associated cardiovascular disease should be further evaluated as a possible target for intervention.

Keywords:

• HIV
• vitamin D
• cardiovascular disease
• intima-media thickness
• carotid plaque

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

The local Medical Ethics Committee of the S.Orsola-Malpighi Hospital approved the study (approval no. 197/2017/O/Oss). All patients provided written informed consent in accordance with the Declaration of Helsinki.

Additional information

Notes on contributors

Leonardo Calza

Leonardo Calza, MD is Associate Professor of Medicine in the Department of Medical and Surgical Sciences, University of Bologna, Italy. He acts as a primary care provider for HIV-infected persons and as a teacher for medical students, residents, and others on the fundamentals of HIV medicine and clinical research. Prof Calza has been involved in the care of HIV-infected patients for more than 20 years, providing care for more than 2500 HIV-infected persons. He is also a member of the expert panel of the Italian Society of Infectious Diseases for the Italian Antiretroviral Therapy Guidelines. Prof Calza received his medical degree from the University of Bologna School of Medicine and completed his residency in Infectious Diseases at the S.Orsola University Hospital in Bologna, Italy.

Marco Borderi

Marco Borderi, MD, is a medical physician acting as a care provider for HIV-infected persons in the Infectious Diseases Unit at the S.Orsola University Hospital in Bologna, Italy. His scientific activities include coordinating and/or principal investigation of several clinical studies, especially on HIV/AIDS. He has served as chairman of numerous scientific national conferences on HIV/AIDS and as an advisor for national and international boards. Dr Borderi received his medical degree from the University of Bologna School of Medicine.

Bianca Granozzi

Bianca Granozzi, MD, is a medical physician and researcher acting as a care provider in the Infectious Diseases Unit at the S.Orsola University Hospital in Bologna, Italy. Her research activities have focused on HIV infection and mycobacterial infections.

Pietro Malosso

Pietro Malosso, MD, is a medical physician and researcher acting as a care provider in the Infectious Diseases Unit at the S.Orsola University Hospital in Bologna, Italy. His research activities have focused on HIV infection and bacterial infections.

Livia Pancaldi

Livia Pancaldi, MD, is a medical physician and researcher acting as a care provider in the Infectious Diseases Unit at the S.Orsola University Hospital in Bologna, Italy. Her research activities have focused on HIV infection and bacterial infections.

Isabella Bon

Isabella Bon, PhD, is a researcher specialist in Virology, in charge of the Retrovirus Laboratory of the Operative Unit of Microbiology, S.Orsola University Hospital in Bologna. Her research activities have focused on viral pathogenetic mechanisms and diagnosis of infection mostly human immunodeficiency virus type 1-2 and other retroviruses (HTLV-I/II). Dr Bon received her medical degree from the University of Bologna School of Medicine.

Maria Carla Re

Maria Carla Re, PhD, is Professor of Microbiology at the University of Bologna School of Medicine in Bologna, Italy. She is specialist in Virology, in charge of the Retrovirus Laboratory of the Operative Unit of Microbiology, S.Orsola University Hospital in Bologna, where she is Director of Operative Unit of Microbiology. Her research activities have focused on viral pathogenetic mechanisms and diagnosis of infection mostly human immunodeficiency virus type 1-2 and other retroviruses (HTLV-I/II).