25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings.

Title25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings.
Publication TypeJournal Article
Year of Publication2014
AuthorsHavers F, Smeaton L, Gupte N, Detrick B, Bollinger RC, Hakim J, Kumarasamy N, Andrade A, Christian P, Lama JR, Campbell TB, Gupta A
Corporate AuthorsACTG PEARLS, NWCS 319 Study Teams
JournalJ Infect Dis
Volume210
Issue2
Pagination244-53
Date Published2014 Jul 15
ISSN1537-6613
KeywordsAdult, Anti-Retroviral Agents, Cohort Studies, Developed Countries, Developing Countries, Disease Progression, Female, HIV Infections, Humans, Male, Risk Factors, Treatment Failure, Vitamin D, Vitamin D Deficiency
Abstract

BACKGROUND: Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking.

METHODS: A case-cohort study (N = 411) was nested within a randomized cART trial of 1571 cART-naive adults in 8 resource-limited settings and the United States. The primary outcome (WHO stage 3/4 disease or death within 96 weeks of cART initiation) was met by 192 cases, and 152 and 29 cases met secondary outcomes of virologic and immunologic failure. We studied prevalence and risk factors for baseline low 25(OH)D (<32 ng/mL) and examined associated outcomes using proportional hazard models.

RESULTS: Low 25(OH)D prevalence was 49% and ranged from 27% in Brazil to 78% in Thailand. Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09-4.18) and virologic failure (aHR 2.42; 95% CI, 1.33-4.41).

CONCLUSIONS: Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure. Studies examining the potential benefit of vitamin D supplementation among HIV patients initiating cART are warranted.

DOI10.1093/infdis/jiu259
Alternate JournalJ. Infect. Dis.
PubMed ID24799602
PubMed Central IDPMC4141201
Grant ListAI069450 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
R2AI45462 / AI / NIAID NIH HHS / United States
T32 AI007291 / AI / NIAID NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069432 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States