OBJECTIVES Optimal vitamin D status is known to have beneficial health effects and vitamin D supplements are commonly used. It has been suggested that vitamin D supplementation may increase blood lead in children and adults with previous lead exposure. The objective was to determine the safety regarding lead toxicity during 12 weeks of high dose vitamin D3 supplementation in children and young adults with HIV. METHODS Subjects with HIV (age 8 to 24 yrs) were randomized to vitamin D3 supplementation of 4000 IU/day or 7000 IU/day and followed at 6 and 12 weeks for changes in 25D and whole blood lead concentration. This was a secondary analysis of a larger study of vitamin D3 supplementation in children and adolescents with HIV. RESULTS In 44 subjects (75% African American), the baseline mean ± SD serum 25D was 48.3 ± 18.6 nmol/L. 50% of subjects had baseline serum 25D < 50.0 nmol/L. Serum 25D increased significantly with D3 supplementation over the 12 weeks. No subject had a whole blood lead >5.0 μg/dL at baseline or during subsequent visits. Whole blood lead and 25D were not correlated at baseline, and were negatively correlated after 12 weeks of supplementation (p= 0.014). Whole blood lead did not differ between those receiving 4000 IU versus 7000 IU of vitamin D3. CONCLUSION High dose vitamin D3 supplementation and the concomitant increased serum 25D did not result in increased whole blood lead concentration in this sample of children and young adults living in a northeastern urban city.

Recent legislative changes to public and private insurance that could expand coverage of IBCLCs have not yielded appreciable changes, particularly in states without Medicaid expansion. There is a need for research on the effects of adopting expanded coverage for IBCLCs and advocacy to do so.