Change in vitamin d levels occurs early after antiretroviral therapy initiation and depends on treatment regimen in resource-limited settings.

TitleChange in vitamin d levels occurs early after antiretroviral therapy initiation and depends on treatment regimen in resource-limited settings.
Publication TypeJournal Article
Year of Publication2014
AuthorsHavers FP, Detrick B, Cardoso SW, Berendes S, Lama JR, Sugandhavesa P, Mwelase NH, Campbell TB, Gupta A
Corporate AuthorsACTG A5175 PEARLS and NWCS319 Study Teams
JournalPLoS One
Volume9
Issue4
Paginatione95164
Date Published2014
ISSN1932-6203
KeywordsAdult, African Americans, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Developing Countries, Female, Health Resources, HIV Infections, Humans, Male, Regression Analysis, Treatment Outcome, Vitamin D
Abstract

STUDY BACKGROUND: Vitamin D has wide-ranging effects on the immune system, and studies suggest that low serum vitamin D levels are associated with worse clinical outcomes in HIV. Recent studies have identified an interaction between antiretrovirals used to treat HIV and reduced serum vitamin D levels, but these studies have been done in North American and European populations.

METHODS: Using a prospective cohort study design nested in a multinational clinical trial, we examined the effect of three combination antiretroviral (cART) regimens on serum vitamin D levels in 270 cART-naïve, HIV-infected adults in nine diverse countries, (Brazil, Haiti, Peru, Thailand, India, Malawi, South Africa, Zimbabwe and the United States). We evaluated the change between baseline serum vitamin D levels and vitamin D levels 24 and 48 weeks after cART initiation.

RESULTS: Serum vitamin D levels decreased significantly from baseline to 24 weeks among those randomized to efavirenz/lamivudine/zidovudine (mean change: -7.94 [95% Confidence Interval (CI) -10.42, -5.54] ng/ml) and efavirenz/emtricitabine/tenofovir-DF (mean change: -6.66 [95% CI -9.40, -3.92] ng/ml) when compared to those randomized to atazanavir/emtricitabine/didanosine-EC (mean change: -2.29 [95% CI -4.83, 0.25] ng/ml). Vitamin D levels did not change significantly between week 24 and 48. Other factors that significantly affected serum vitamin D change included country (p<0.001), season (p<0.001) and baseline vitamin D level (p<0.001).

CONCLUSION: Efavirenz-containing cART regimens adversely affected vitamin D levels in patients from economically, geographically and racially diverse resource-limited settings. This effect was most pronounced early after cART initiation. Research is needed to define the role of Vitamin D supplementation in HIV care.

DOI10.1371/journal.pone.0095164
Alternate JournalPLoS ONE
PubMed ID24752177
PubMed Central IDPMC3994063
Grant ListAI069450 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
R01 AI45462 / AI / NIAID NIH HHS / United States
T32 AI007291 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069399 / AI / NIAID NIH HHS / United States
UM1 AI069432 / AI / NIAID NIH HHS / United States
UM1 AI069463 / AI / NIAID NIH HHS / United States