Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana

Abstract

Background Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. There is less evidence on prevalence of vitamin D deficiency and nutrition and growth in HIV-infected and-exposed children in lowand middle-income countries. Objectives To determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and-infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth. Methods This was a cross-sectional study of HIV+ mothers and HIV-exposed infants and unrelated children (1-7.9 years). Serum 25-hydroxyvitamin D (25(OH)D) was measured, among other nutritional indicators, for mothers, infants and children. Vitamin D status for HIV-infected mothers and children, and an immune panel was assessed. History of HIV anti-retroviral medications and breastfeeding were obtained. Data were collected prior to universal combination antiretroviral therapy in pregnancy.

The role of vitamin D status on treatment outcome among HIV- infected children receiving care in Kisumu County, Kenya

“…Moreover, much lower levels of serum vitamin D have equally been observed among late ART-initiated children (18 months to 12 years) as compared to those on early-ART initiation in the rst year of life [22], but this is explained by the in uence of increasing age on vitamin D levels reported in our study; and is consistent with children physiological parameters such as bone mineral density [17].Thus, our nding supported an earlier systematic review and meta-analysis report showing increased risk of vitamin D de ciency in PLWH compared to uninfected subjects; more so to participants receiving ART, and in older age category [24]. Slightly lower levels of vitamin D among HIV infected infants and adults on ART have equally been reported in a similar study in Botswana [4], although this was partly attributed to demographic and dietary habits of consuming more of traditional and indigenous foods enriched with better dietary diversity [4] Additionally, we compared the proportion of Immunocompromised participants with Immunocompetent group based on their vitamin D levels, and established that majority participants who experienced vitamin D de ciency or insu ciency were actually Immunocompetent rather than Immunocompromised; and consistent with earlier ndings by Kakalia et al, [25]. To the contrary, our ndings dispelled earlier report suggesting a possible correlation between vitamin D levels and CD4 + T-cell counts [3,5,26].…”

“…Moreover, much lower levels of serum vitamin D have equally been observed among late ART-initiated children (18 months to 12 years) as compared to those on early-ART initiation in the first year of life [ 22 ], but this is explained by the influence of increasing age on vitamin D levels reported in our study; and is consistent with children physiological parameters such as bone mineral density [ 17 ].Thus, our finding supported an earlier systematic review and meta-analysis report showing increased risk of vitamin D deficiency in PLWH compared to uninfected subjects; more so to participants receiving ART, and in older age category [ 24 ]. Slightly lower levels of vitamin D among HIV infected infants and adults on ART have equally been reported in a similar study in Botswana [ 4 ], although this was partly attributed to demographic and dietary habits of consuming more of traditional and indigenous foods enriched with better dietary diversity [ 4 ]…”

“…Instead, vitamin D concentrations above 30 ng/ml has been found to be more associated with mortality of HIV infected children compared to levels lower than 10 ng/ml [ 21 ]. Meanwhile, a good number of local and international studies have reported varying relationship; both positive and negative, with others failing to demonstrate any correlation [ 27 ] A recent study in the neighborhood Uganda associated low CD4 count with vitamin D deficiency [ 5 ]; thus, echoing other findings from related studies in France and Colombia which equally suggested that severe vitamin D deficiency could be independently associated with low CD4 count [ 3 , 4 , 28 ]. Although high CD4 cells counts have been associated with higher vitamin D levels [ 29 ], while low vitamin D levels is linked to immune dysfunction that also influence the expression of inflammatory markers [ 24 ], we could not establish this outcome owing to the scope of our study.…”

“…About 40% of the 1 million HIV infected children < 15 years of age, receiving antiretroviral treatment (ART) care in sub Saharan Africa have not achieved the desired viral suppression (de ned as viral load < 200 copies /ml) despite improved implementation of more e cacious 1st line ART regimens [1], possibly due to vitamin D de ciency. Plasma vitamin D [de ned as 25 hydroxyvitamin D (25(OH)D] is a steroid hormone, fat-soluble micronutrient obtained primarily from ultraviolent B rays and plays crucial roles of balancing homeostasis, regulating mineral metabolism, bone maintenance, cell growth, and immune response useful in containing infectious diseases [2][3][4][5]. De ciency of vitamin D therefore, promotes in ammatory responses by upregulating in ammatory markers such as IL-6 and TNF-α overproduction in HIV-infected patients [2,6], leading to renal 1𝛼-hydroxylase impairment with reduction of parathyroid hormone (PTH) stimulatory effect on the production of hormonally active 1,25 dihydroxyvitamin D [1,25(OH)2D] [7].…”

Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth

“…With respect to vitamin D status, the information provided contributes to the open issue of prevalence of vitamin D deficiency in Africa, which is characterized by large variability among countries based on the reported prevalence of this condition [ 37 ]. The low rates of deficiency and insufficiency observed in our study in six-month-old African infants provide some reassurance, confirming that vitamin D deficiency is less common in infants this age or older than in neonates or 6–10-week-old infants [ 50 , 51 , 52 , 53 , 54 ], with no apparent negative effect related to HIV exposure. Vitamin D supplementation was not provided to infants in this study.…”