Risk Factors for Vitamin D Deficiency among HIV-Infected and Uninfected Injection Drug Users

<div><p>Introduction</p><p>Vitamin D deficiency is highly prevalent and is associated with bone disease, cardiovascular disease, metabolic syndrome and malignancy. Injection drug users (IDUs), with or without HIV infection, are at risk for these conditions; however, limited data on vitamin D deficiency exist in this population. We determined the prevalence and correlates of vitamin D deficiency among urban IDUs in the AIDS Linked to the IntraVenous Experience (ALIVE) Study cohort.</p><p>Methods</p><p>For this cross-sectional sub-study, vitamin D deficiency was defined as a serum 25(OH)-vitamin D level <20 ng/mL. Multivariable logistic regression was used to identify factors independently associated with vitamin D deficiency.</p><p>Results</p><p>Of 950 individuals analyzed, 29% were HIV-infected. The median age was 49 years; 65% were male, and 91% were black. The median vitamin D level was 13.5 ng/mL (IQR, 9.0–20.3); 74% were deficient (68% in HIV-infected vs. 76% in HIV-uninfected, p = 0.01). Non-black race, fall/winter season, multivitamin intake, higher serum albumin, HCV seropositivity and HIV-infection were associated with significantly lower odds of vitamin D deficiency.</p><p>Conclusions</p><p>Vitamin D deficiency is prevalent among IDUs. Notably, HIV-infected IDUs were less likely to be vitamin D deficient. Higher vitamin D levels were associated with multivitamin intake and with higher albumin levels, suggesting that nutritional status contributes substantially to deficiency. The association between HCV serostatus and vitamin D level remains unclear. Further investigation is needed to define the clinical implications of the heavy burden of vitamin D deficiency in this high-risk, aging population with significant co-morbidities.</p></div

Association between Entire Cohort Characteristics and Vitamin D Deficiency (n = 950).

<p>Models adjusted for other variables in table.</p><p>* As compared to spring season of measurement.</p>†<p>In the previous 6 months.</p><p>Abbreviations: BMI, body mass index; CI, confidence interval; HCV, hepatitis C virus; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; OR, odds ratio.</p

Sociodemographic and Clinical Characteristics of Study Participants.

<p>Values presented as n(%) or median (IQR) unless indicated otherwise.</p><p>* In the previous 6 months.</p>†<p>n = 383</p>‡<p>Among participants with HIV.</p><p>Abbreviations: BMI, body mass index; BP, blood pressure; ER, emergency room; HAART, highly active antiretroviral therapy; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IQR, interquartile range; kPA, kilopascal; RNA, ribonucleic acid; SD, standard deviation; UD, undetectable; VitD, 25(OH)-vitamin D; WBC, white blood cell.</p

Frailty, HIV Infection, and Mortality in an Aging Cohort of Injection Drug Users

<div><h3>Background</h3><p>Frailty is associated with morbidity and premature mortality among elderly HIV-uninfected adults, but the determinants and consequences of frailty in HIV-infected populations remain unclear. We evaluated the correlates of frailty, and the impact of frailty on mortality in a cohort of aging injection drug users (IDUs).</p> <h3>Methods</h3><p>Frailty was assessed using standard criteria among HIV-infected and uninfected IDUs in 6-month intervals from 2005 to 2008. Generalized linear mixed-model analyses assessed correlates of frailty. Cox proportional hazards models estimated risk for all-cause mortality.</p> <h3>Results</h3><p>Of 1230 participants at baseline, the median age was 48 years and 29% were HIV-infected; the frailty prevalence was 12.3%. In multivariable analysis of 3,365 frailty measures, HIV-infected IDUs had an increased likelihood of frailty (OR, 1.66; 95% CI, 1.24–2.21) compared to HIV-uninfected IDUs; the association was strongest (OR, 2.37; 95% CI, 1.62–3.48) among HIV-infected IDUs with advanced HIV disease (CD4<350 cells/mm3 and detectable HIV RNA). No significant association was seen with less advanced disease. Sociodemographic factors, comorbidity, depressive symptoms, and prescription drug abuse were also independently associated with frailty. Mortality risk was increased with frailty alone (HR 2.63, 95% CI, 1.23–5.66), HIV infection alone (HR 3.29, 95% CI, 1.85–5.88), and being both HIV-infected and frail (HR, 7.06; 95%CI 3.49–14.3).</p> <h3>Conclusion</h3><p>Frailty was strongly associated with advanced HIV disease, but IDUs with well-controlled HIV had a similar prevalence to HIV-uninfected IDUs. Frailty was independently associated with mortality, with a marked increase in mortality risk for IDUs with both frailty and HIV infection.</p> </div

Factors Associated with Frailty and Prefrailty among 3365 ALIVE Study Person-Visits^a.

<p>Abbreviations : HAART, highly active antiretroviral therapy; VL, HIV viral load; UD, undetectable, <50 HIV RNA copies/ml; Hazardous alcohol use, score of ≥8 on the AUDIT; Depressive symptoms, score of ≥21 on the CES-D.</p><p>– Not included in final model/not significant in adjusted analyses.</p>a<p>Data are given as unadjusted and adjusted odds ratios (95% confidence interval).</p>b<p>Adjusted for age, gender, race, education, marital status, prescription drug abuse, depressive symptoms, # comorbid conditions and HIV status.</p>c<p>Adjusted for age, gender, race, education, marital status, prescription drug abuse, depressive symptoms, and # comorbid conditions.</p>d<p>Reflect characteristics within the previous 6 months.</p>e<p>Reflect characteristics within the prior year.</p>f<p>Diabetes, Hypertension, Cerebrovascular accident, Cardiovascular disease, Renal disease, Chronic obstructive pulmonary disease, Cancer, Obesity, Liver disease.</p

Survival by Frailty and HIV Status in the ALIVE cohort.

<p>Kaplan Meier Survival Curve Estimates for 1230 ALIVE Participants from July 2005 to December 2008. Frail- participants had a frailty score of 0–2; Frail+ participants had a frailty score of 3–5.</p

Adjusted^§ mean physical component summary (PCS) and mental component summary (MCS) scores on the Short Form-36 by self-reported severity of body fat changes at baseline and follow-up visit among HIV+ men.

§<p>All models were adjusted for age, race (white vs other), education (college vs no college), HAART use at the time of the visit, co-morbidity score, and proportion of previous post-HAART visits with plasma HIV-1 RNA (viral load) <400 copies/ml.</p><p>95% CI: 95% Confidence Interval; † p value comparing baseline to follow-up; * p value <0.05 compared within visit to category “none”</p><p>Adjusted^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114166#nt103" target="_blank">§</a>} mean physical component summary (PCS) and mental component summary (MCS) scores on the Short Form-36 by self-reported severity of body fat changes at baseline and follow-up visit among HIV+ men.</p

Participant Characteristics at Baseline Visit (5 +/−1 years after Highly Active Antiretroviral Therapy [HAART] initiation) and Follow-up Visit (median 7.5 years later).

<p>Values presented as number (%) or median (25^th, 75^th percentile).</p><p>Co-morbidity score defined as the sum number of the following co-morbid conditions: 1) depression, 2) hypertension, 3) diabetes mellitus, 4) dyslipidemia, 5) kidney Disease, 6) liver disease, 7) cancer within 1 year.</p><p>Participant Characteristics at Baseline Visit (5 +/−1 years after Highly Active Antiretroviral Therapy [HAART] initiation) and Follow-up Visit (median 7.5 years later).</p

Association between Patient Characteristics and Vitamin D Deficiency among HIV-Infected Participants (n = 278).

<p>Models adjusted for other variables in table.</p><p>*As compared to spring season of measurement.</p>†<p>In the previous 6 months.</p><p>Abbreviations: BMI, body mass index; CI, confidence interval; HCV, hepatitis C virus; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; OR, odds ratio.</p

Characteristics of 1230 ALIVE Participants at 3365 Study Visits, by HIV Status^a.

<p>Abbreviations: HAART, highly active antiretroviral therapy; IQR, interquartile range; y, years; Hazardous alcohol use, score of ≥8 on the AUDIT; Depressive symptoms, score of ≥21 on the CES-D.</p>a<p>Data are no. (%) of participants, unless otherwise indicated.</p>b<p>Reflect characteristics within the previous 6 months.</p>c<p>Reflect characteristics within the prior year.</p>d<p>Diabetes, Hypertension, Cerebrovascular accident, Cardiovascular disease, Renal disease, Chronic obstructive pulmonary disease, Cancer, Obesity, Liver disease.</p