ESPID Education. Gavin P. Jun 7, 2011; 7790
Dr. Patrick Gavin
Dr. Patrick Gavin

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In addition to its key role in bone mineral metabolism, Vitamin D has important
immunomodulatory and antiinfective properties. Development of clinical rickets in
a 14 year old boy on HAART (FTC/TDF/EFV) prompted an audit of Vitamin D
status in our HIV infected cohort
Cross sectional study of vertically HIV infected children attending the National
Centre for Paediatric HIV Medicine in Ireland. Serum 1, 25 (OH) vitamin D levels
were defined as: deficient, <27.5nmol/L; low, 27.5nmol/L; and normal, >75nmol/L.
Parathormone (PTH) levels <65ng/mL were considered normal.
Data were available on 66 children (35 male). Ethnicity: African, 52; Caucasian,
11; and mixed African-Caucasian, 3. Fifty one children were receiving HAART
(TDF, 20, EFV, 20 and 8/20 both TDF and EFV). Mean Vitamin D level was
43nmol/l (range, 7.8-112.2). Vitamin D levels were deficient, 15 (23%), low, 45
(68%) and normal, 6 (9%). Mean PTH level 64ng/ml (range, 15.8 – 804).
PTH levels were elevated in 10 (16%) of whom 7 (11%) were Vit D deficient with
elevated PTH levels, 3 with associated hypocalcaemia and hypophosphataemia.
Two received EFV; 1 TDF; 3 TDF/EFV and 1 was treatment naïve.
Urinary Calcium/Creatinine and Protein Creatinine ratios were normal in 42 of 43
(98%) children. One child had pre-existing HIV Nephropathy.
The majority (60/66, 91%) of our cohort of vertically infected children have low
vitamin D levels. PTH levels were elevated in 15%. In the absence of
demonstrable renal dysfunction, further study of additional mechanisms e.g.
inadequate intake, decreased absorption, drug effect, insufficient sunlight,
ethnicity is warrented.
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