Risk Factors for Vitamin D Deficiency and Relationship with Cardiac Biomarkers, Inflammation and Immune Restoration in HIV-Infected Youth

Abstract

Background Vitamin D deficiency is common in HIV-infected individuals. In adults, traditional and HIV-related factors play a role in vitamin D status, and deficiency appears to impair immune restoration and exacerbate HIV complications, like cardiovascular disease (CVD). This study sought to determine factors contributing to vitamin D status in HIV-infected youth and investigate the relationship with CVD risk, inflammation, and immune restoration. Methods HIV-infected subjects (1–25 years old) were enrolled prospectively along with healthy controls that were group-matched by age, sex, and race. HIV data were collected for the HIV-infected group, while traditional risk factors, including vitamin D intake, sun exposure, skin pigmentation, physical activity level, and body mass index (BMI) were collected for both groups. Fasting lipids, plasma 25-hydroxyvitamin D (25(OH)D), and inflammation markers were measured. Results 200 HIV-infected subjects and 50 controls were enrolled. HIV group had 53% male, 95% black, and a mean age of 17.2±4.6 years. There was no difference in 25(OH)D between groups; 77% of HIV+ and 74% of controls had 25(OH)D <20 ng/mL. Only Fitzpatrick skin type was independently associated with 25(OH)D. No HIV variables were associated with 25(OH)D, even when HIV sub-populations were examined. Inflammation, CVD risk factors, and immune restoration were not independently associated with 25(OH)D. Conclusions Vitamin D deficiency is common among HIV-infected youth. However, HIV factors, CVD risk, inflammation, and immune restoration do not appear to have the same relationship with vitamin D as has been shown in adults. Supplementation trials are needed to determine if increasing 25(OH)D concentrations could better elucidate these relationships.

Safety and Efficacy of High-Dose Daily Vitamin D3 Supplementation in Children and Young Adults Infected With Human Immunodeficiency Virus

“…Subjects receiving tenofovir did not differ at baseline or in the change in 25 In a few studies evaluating children and young adults with HIV infection, researchers found a high prevalence of suboptimal 25(OH)D, ranging from 71% to 89% <30 ng/mL [3,[26][27][28]] to 33% to 78% <20 ng/mL [1,4,[29][30][31], with 1 group reporting 87% <15 ng/mL [2]. Our results support the finding that suboptimal 25(OH)D status is common in unsupplemented youth, with 95% at baseline having a 25(OH)D <32 ng/mL.…”

LL-37 Concentrations and the Relationship to Vitamin D, Immune Status, and Inflammation in HIV-Infected Children and Young Adults

“…[1][2][3] We and others have demonstrated > 90% of subjects with HIV have concentrations < 30 ng/ml, which has been suggested to be optimal for vitamin D status. 2,[4][5][6] While the causes of vitamin D deficiency in HIV are multifactorial, including inadequate diet and darker skin pigmentation, certain commonly prescribed antiretroviral medications, particularly efavirenz, have been shown to interfere with normal vitamin D metabolism. 2,4,5 Vitamin D is a steroid hormone that has long been known to play a critical role in the immune system, including effects on innate immunity, adaptive immunity, and levels of inflammatory cytokines, including interleukin-6 (IL-6).…”

“…2,[4][5][6] While the causes of vitamin D deficiency in HIV are multifactorial, including inadequate diet and darker skin pigmentation, certain commonly prescribed antiretroviral medications, particularly efavirenz, have been shown to interfere with normal vitamin D metabolism. 2,4,5 Vitamin D is a steroid hormone that has long been known to play a critical role in the immune system, including effects on innate immunity, adaptive immunity, and levels of inflammatory cytokines, including interleukin-6 (IL-6). [7][8][9][10] In non-HIV populations, an individual's vitamin D status affects their susceptibility to tuberculosis, the disease severity, and their response to treatment.…”

Short Communication: High Prevalence of Vitamin D Deficiency in HIV-Infected and HIV-Uninfected Pregnant Women

“…These data are consistent with vitamin D deficiency prevalence from recent National Health and Nutrition Examination Survey (NHANES) data 12 and from studies evaluating other nonpregnant HIV-infected populations. [1][2][3] Another NHANES study demonstrated no overall statistical difference between rates of deficiency between pregnant and nonpregnant women. 13 While the rates are higher in this study compared to some studies of pregnant women, they are consistent with others, depending on the population studied.…”

“…[1][2][3] Low vitamin D status appears to negatively affect HIV progression and mortality in nonpregnant populations. 4 Similarly, vitamin D deficiency has not only been shown to contribute to HIV disease progression and mortality in HIVinfected pregnant women in resource-limited settings, but also increases the overall risk of mother-to-child transmission (MTCT) by 46%.…”