The Potential Protective Role of Vitamin D Supplementation on HIV-1 Infection

Abstract

HIV infection remains a global and public health issue with the incidence increasing in some countries. Despite the fact that combination antiretroviral therapy (cART) has decreased mortality and increased the life expectancy of HIV-infected individuals, non-AIDS conditions, mainly those associated with a persistent inflammatory state, have emerged as important causes of morbidity, and mortality despite effective antiviral therapy. One of the most common comorbidities in HIV-1 patients is Vitamin D (VitD) insufficiency, as VitD is a hormone that, in addition to its physiological role in mineral metabolism, has pleiotropic effects on immune regulation. Several reports have shown that VitD levels decrease during HIV disease progression and correlate with decreased survival rates, highlighting the importance of VitD supplementation during infection. An extensive review of 29 clinical studies of VitD supplementation in HIV-infected patients showed that regardless of cART, when VitD levels were increased to normal ranges, there was a decrease in inflammation, markers associated with bone turnover, and the risk of secondary hyperparathyroidism while the anti-bacterial response was increased. Additionally, in 3 of 7 studies, VitD supplementation led to an increase in CD4+ T cell count, although its effect on viral load was inconclusive since most patients were on cART. Similarly, previous evidence from our laboratory has shown that VitD can reduce the infection of CD4+ T cells in vitro. The effect of VitD supplementation on other HIV-associated conditions, such as cardiovascular diseases, dyslipidemia or hypertension, warrants further exploration. Currently, the available evidence suggests that there is a potential role for VitD supplementation in people living with HIV-1, however, comprehensive studies are required to define an adequate supplementation protocol for these individuals.

Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana

“…Data were collected prior to universal cART in pregnancy, which may have affected the mean CD4%. The present study echoes the favorable relation between vitamin D status and immune outcomes reported elsewhere [34,35].…”

Evidence That Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

“…In 3 of 7 studies, CD4+ T cell count increased, but effect on viral load was inconclusive since most patients were on cART. [112] H9N2 influenza…”

Possible role of vitamin D in Covid-19 infection in pediatric population

“…In particular, the paper reports that supplementation with a daily dose of vitamin D between 4000-7000 IU for at least 12 weeks can reduce the expression of CD38 and Ki67 in CD8+ T lymphocytes, inflammatory monocytes (CD14+ CD16+), as well as the expression of PD1 + (an exhaustion marker) in CD4+ T cells, with an increase in CD4+/CD8+ T cell ratio. This leads to the important assumption that brisk supplementation in vitamin D-deficient HIV-infected patients could help reduce chronic inflammation and comorbidities [16] that are still frequent among these patients despite the constant amelioration of combination antiretroviral therapy (cART) [17]. Human cathelicidin peptide LL37 also modulates the recognition of viral dsRNA by Toll-like receptor 3 (TLR 3).…”