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. 2012;7(6):e40036.
doi: 10.1371/journal.pone.0040036. Epub 2012 Jun 29.

Vitamin D and HIV progression among Tanzanian adults initiating antiretroviral therapy

Christopher R Sudfeld  1 , Molin Wang, Said Aboud, Edward L Giovannucci, Ferdinand M Mugusi, Wafaie W Fawzi
Affiliations

Vitamin D and HIV progression among Tanzanian adults initiating antiretroviral therapy

Christopher R Sudfeld et al. PLoS One. 2012.

Abstract

Background: There is growing evidence of an association between low vitamin D and HIV disease progression; however, no prospective studies have been conducted among adults receiving antiretroviral therapy (ART) in sub-Saharan Africa.

Methods: Serum 25-hydroxyvitamin D (25(OH)D) levels were assessed at ART initiation for a randomly selected cohort of HIV-infected adults enrolled in a trial of multivitamins (not including vitamin D) in Tanzania during 2006-2010. Participants were prospectively followed at monthly clinic visits for a median of 20.6 months. CD4 T-cell measurements were obtained every 4 months. Proportional hazard models were utilized for mortality analyses while generalized estimating equations were used for CD4 T-cell counts.

Results: Serum 25(OH)D was measured in 1103 adults 9.2% were classified as vitamin D deficient (<20 ng/ml), 43.6% insufficient (20-30 ng/mL), and 47.2% as sufficient (>30 ng/mL). After multivariate adjustment, vitamin D deficiency was significantly associated with increased mortality as compared to vitamin D sufficiency (HR: 2.00; 95% CI: 1.19-3.37; p = 0.009), whereas no significant association was found for vitamin D insufficiency (HR: 1.24; 95% CI: 0.87-1.78; p = 0.24). No effect modification by ART regimen or change in the associations over time was detected. Vitamin D status was not associated with change in CD4 T-cell count after ART initiation.

Conclusions: Deficient vitamin D levels may lead to increased mortality in individuals receiving ART and this relationship does not appear to be due to impaired CD4 T-cell reconstitution. Randomized controlled trials are needed to determine the safety and efficacy of vitamin D supplementation for individuals receiving ART.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Kaplan-Meier estimation of progression to all-cause mortality by vitamin D status.
Figure 2
Figure 2. Restricted cubic spline analysis illustrating the shape of the serum 25(OH)D and all-cause mortality association (hazard ratio) continuously with 30 ng/mL as the referent level.
Adjusted for baseline sex, age, season, BMI, WHO HIV disease stage, and CD4 T-cell count.
Figure 3
Figure 3. Crude CD4 T-cell count overtime by vitamin D status.
See this image and copyright information in PMC

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