Vitamin D Deficiency: Related to HIV?

wikipedia.org

This is an interesting retrospective cohort study published by Sherwood and colleagues looking at vitamin D deficiency (VDD) in patients with and without HIV in a cohort of military beneficiaries; VDD was defined as having a 25-OH vitamin D level < 20 ng/mL and data were collected in the early 2000s. 165  patients with HIV were matched to controls; overall, 85% of patients were male and 61% were black. Patients with HIV were not significantly more likely to have VDD; VDD was associated with black ethnicity regardless of HIV status. Low bone mineral density (BMD) was associated with low exercise, low BMI and with alcohol use, but not with VDD. Low BMD was not associated with tenofovir or other antiretroviral exposure, although there was little tenofovir exposure in this cohort (data primarily collected in early 2000s). 

On the clinical "front lines" it is often difficult to know how aggressively one should manage low vitamin D levels in HIV positive patients: is the concomitant increase in 'pill burden' and its potential negative impact on long-term compliance worth the possible benefit to bone health? If some studies, such as this one, indicate no relationship between bone mineral density and vitamin D levels, are we treating a lab value and not the patient? If VDD and BMD are not definitively linked, why check vitamin D levels at all? Although this study is valuable it does not answer these critical questions; it would be interesting to see this study repeated in the current practice era (e.g., using modern antiretroviral agents according to current practice standards).