The relationship between vitamin D status and HIV-related complications in HIV-infected children and young adults

Abstract

Background: In HIV-infected adults, we and others have shown that vitamin D deficiency is independently associated with increased carotid intima-media thickness (cIMT), a surrogate marker for cardiovascular disease (CVD). This study explored for the first time the relationship between vitamin D and CVD risk in HIV-infected youth.

Methods: This is a cross-sectional assessment of cIMT, inflammation, metabolic markers and vitamin D status in HIV-infected youth and healthy controls. We measured serum 25-hydroxyvitamin D (25(OH)D), fasting lipids, insulin, glucose, inflammatory markers and cIMT.

Results: Thirty HIV-infected subjects and 31 controls were included. Among HIV-infected subjects, median age was 11 years (37% males; 73% black; similar to controls). HIV-infected subjects' mean (standard deviation) serum 25(OH)D was 24 (35) ng/mL; 70% had 25(OH)D<20 ng/mL (deficient), 23% between 20-30 ng/mL (insufficient) and 7%>30 ng/mL (sufficient); proportions were similar to controls (P=0.17). After adjusting for season, sex and race, there was no difference in serum 25(OH)D between groups (P=0.11). Serum 25(OH)D was not significantly correlated with cIMT, inflammatory markers or lipids. Serum 25(OH)D was negatively correlated with body mass index, insulin resistance, HIV duration, and cumulative use of antiretroviral therapy, non- and nucleoside reverse transcriptase inhibitors.

Conclusions: Most HIV-infected youth have vitamin D deficiency or insufficiency. Despite no direct association between serum 25(OH)D and cIMT, there were notable associations with some CVD risk factors, particularly inverse correlation with insulin resistance. Studies are needed to determine whether CVD risk, including insulin resistance, could be improved with vitamin D supplementation.

Figure 1. Percentage of HIV-infected subjects and healthy controls with vitamin D deficiency, insufficiency, and sufficiency

This figure shows the proportion of subjects by study group in each category of vitamin D status based on serum concentrations of 25(OH)D. Vitamin D deficiency is defined as 25(OH)D <20 ng/mL, vitamin D insufficiency as 25(OH)D ≥20–29 ng/mL, and optimal vitamin D status as 25(OH)D >29 ng/mL. There was no difference between groups in the proportions of subjects in each vitamin D status category (P = 0.17). The majority of subjects from both groups were in the vitamin D deficient range. One HIV-infected subject was inadvertently taking mega-doses of vitamin D and had a 25(OH)D concentration of 204 ng/mL. 25(OH)D, 25-hydroxyvitamin D