Vitamin D3 supplementation in HIV infection: effectiveness and associations with antiretroviral therapy

Abstract

BackgroundHIV infection and antiretroviral therapy (ART) may create unique risk factors for vitamin D insufficiency, including alterations of vitamin D metabolism by ART. We prospectively compared demographic and clinical parameters between vitamin D sufficient and insufficient HIV-infected (HIV+) adults, and assessed changes in these parameters among insufficient participants following standardized vitamin D supplementation.MethodsHIV+ adults (≥18 years old) with HIV-1 RNA <50 copies/mL on ART were enrolled. Vitamin D sufficiency and insufficiency were defined as 25-hydroxyvitamin D (25(OH)D) ≥30 or <30 ng/mL, respectively. Insufficient participants received open-label vitamin D3 50,000 IU twice weekly for 5 weeks, then 8000 IU twice weekly to complete 24 weeks. The primary endpoint was success or failure to achieve 25(OH)D ≥30 ng/mL at week 24.ResultsNinety-seven participants enrolled (34 vitamin D sufficient, 63 insufficient); 32 % female, 47 % non-White, median age 46 years, ART duration 5 years, CD4+ T lymphocyte count (CD4) 673 cells/mm3. 25(OH)D repletion was 83 % (95 % CI 71 %–90 %) successful. 25(OH)D levels correlated with both CD4 (r = 0.44, p = 0.01) and time on protease inhibitor (r = −0.35, p = 0.01). After adjusting for age, sex, race, nadir CD4 and baseline 25(OH)D: 1) current use of efavirenz exposure was associated with a 21.1 ng/mL higher week 24 25(OH)D level (p = 0.007), 2) per year use of zidovudine was associated with 7.1 ng/mL reduction in week 24 serum 25(OH)D (p = 0.05) and 3) every 1 ng/mL 25(OH)D increase was associated with a 3.3 cell/mm3 CD4 increase (p = 0.06).ConclusionVitamin D3 supplementation was effective in repleting 25(OH)D levels after 24 weeks. Current efavirenz use was positively associated with post-repletion 25(OH)D levels, while greater time on zidovudine was associated with lower post-repletion 25(OH)D levels. The association between improved CD4 recovery and vitamin D repletion suggests a potential benefit of vitamin D supplementation on immunologic recovery during HIV treatment.Trial registrationThis trial is registered at The Brazilian Clinical Trials Registry (U1111‐1165‐2537).Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-015-0072-6) contains supplementary material, which is available to authorized users.

Mechanisms of Action of Vitamin D as Supplemental Therapy for Pneumocystis Pneumonia

“…Although we have clearly demonstrated anti-infective and anti-inflammatory functions of vitamin D in mice, it is not known whether similar effects would occur in humans with PCP. It has been reported that 65% (63 of 97) of HIV-infected patients are deficient in vitamin D and that vitamin D supplementation for 24 weeks significantly increased the number of CD4 ϩ cells in these patients (54). This observation suggests that vitamin D supplementation would help resolve PCP in humans.…”

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

“…Coelho et al. reported that plasma 25(OH)D levels were significantly positively correlated with CD4 + T‐cell counts after 24 weeks of VitD supplementation and that each 1.0 ng/ml increase in 25(OH)D during repletion therapy was associated with a 3.3 cell/µl increase in the CD4 + T‐cell count . Although others have found that VitD supplementation is associated with reduced immune activation and CD4 + T‐cell exhaustion levels, it has no effect on CD4 + T‐cell recovery in both untreated and treated HIV‐1‐infected individuals .…”

Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor?

“…VDD is a common finding in HIV-infected patients. Coelho et al found that 63 out of 97 adult patients on antiretroviral therapy presented with insufficient levels of VD [ 72 ]. The investigators also showed that VD supplementation over 24 weeks improved CD4+ cell count recovery [ 72 ].…”