INSULIN RESISTANCE AND HIGH CHOLESTEROL LEVELS ARE ASSOCIATED WITH VITAMIN D DEFICIENCY IN HCV, HIV AND HIV/HCV COINFECTED PATIENTS

Abstract

Background and Aims: Vitamin D plays a role in metabolic syndrome and has also been suggested as an immunomodulator. Lower levels are correlated with severe fibrosis in HCV and HIV/HCV coinfected patients and predict lower response to treatment in those individuals. The aim is to evaluate levels of 25(OH)vitamin D among a population of HCV, HIV and HIV/HCV coinfected patients and describe associated factors. Patients and Methods: We collected 25(OH)vitamin D samples, demographic data, clinical information and laboratory tests including liver function and metabolic assessment of four groups of patients; 1 – HCV monoinfected, 2 – HIV monoinfected, 3 – HIV/HCV coinfected, followed at reference centres of São Paulo-Brazil and 4 – Healthy Volunteers Control Group. Results: 422 patients were included for analysis, (129) Group 1, (118) Group 2, (53) Group 3 and (122) Group 4. Mean levels of Vitamin D were similarly insufficient in all groups (Table 1). Table 1. Mean Levels of Vitamin D in the 4 groups Groups n Mean (ng/mL) St. D. St. E. Median (ng/mL) IQ.D Min (ng/mL) Max (ng/mL) 1– HCV 129 23.4 10.1 0.89 23 13 5 55 2– HIV 118 19.5 9.2 0.85 18 12 4 50 3– HIV/HCV 53 24.1 12.9 1.77 22 15 3 66 4– Control 122 17.1 5.9 0.54 17 8.75 6 32 In an overall analysis, Vitamin D deficiency (serum levels < 20ng/mL) was associated with higher HOMA index (Graph 1 – p=0.02 Fisher test) and total cholesterol levels > 200 (p=0.004 Fisher test). When analyzed by Groups, Vitamin D deficiency was associated with: 1. Higher HOMA levels in HCV patients (Grap h 2 – p=0.004 Fisher test), 2. Use of Efavirenz both in HIV (Graph 3 – p=0.03 OR=6.69 95%CI: 1.17–38.3) and Coinfected Patients (p=0.04 OR=15.0 95%CI: 1.22–184). Conclusion: This study found high prevalence of vitamin D deficiency, even in healthy volunteers. The association between Insulin Resistance (IR) and Vitamin D deficiency has been demonstrated in other populations, but not previously described in HCV patients. This finding is relevant because both IR and Vitamin D deficiency are related to poor treatment outcomes of Interferon-based regimens.