Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: A longitudinal study

Abstract

Summary Background & aims We implemented a prospective study among human immunodeficiency virus (HIV)-positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4+T-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4+T-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4+T-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4+T- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4+T-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/μl (99% CI: −77, 26) to a maximum deficit of 65 cells/μl (99% CI: −125, −5.5) during follow-up. This VDD-associated lower absolute CD4+T-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions VDD is associated with lower absolute CD4+T-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4+T-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.

Vitamin D status and risk of incident tuberculosis disease: a systematic review and individual participant data meta-analysis

“…Although we did not detect a statistically significant interaction between vitamin D levels and HIV status, our findings raise the possibility that the effect of low vitamin D on TB risk may be more pronounced among HIV-positive patients. Studies have shown that among HIV-infected individuals, VDD is associated with deleterious immune activation, 44 lower CD4 counts, 44,45 higher viral loads, 44 and accelerated HIV disease progression. 44,46 Thus, VDD may exacerbate existing immune dysregulation in HIV infection to further increase TB risk or low vitamin D levels may reflect severity of HIV-related immunosuppression.…”

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

“…Vitamin D (VitD) is a key regulator of host defense against infections by activating genes and pathways that enhance innate and adaptive immunity . Several studies have demonstrated that baseline VitD deficiency in HIV‐1‐infected individuals was associated with diminished CD4 + T‐cell recovery after ART initiation . This effect may be partially explained by the fact that sufficient VitD levels can reduce inflammation and T cell activation, restrain HIV‐1 infection in T cells, and promote the proliferation of CD4 + T cells induced by APCs .…”

“…203 Several studies have demonstrated that baseline VitD deficiency in HIV-1-infected individuals was associated with diminished CD4 + T-cell recovery after ART initiation. [204][205][206][207] This effect may be partially explained by the fact that sufficient VitD levels can reduce inflammation and T cell activation, restrain HIV-1 infection in T cells, and promote the proliferation of CD4 + T cells induced by APCs. 207,208 These observations suggest that the baseline metabolic characteristics may be associated with impaired immune reconstitution in HIV-1-infected individuals during ART.…”

Vitamin D in pediatric health and disease

“…They also have a higher risk of a respiratory tract infection before this age . VD deficiency is common in HIV‐infected patients, and this appears to be related to faster progression of AIDS, elevated mortality, and a higher risk of mother‐to‐child transmission . Taken together, these results suggest that VD may not only support the innate immune system but also support the adaptive immune system and it plays a role in the fight against pathogens, suggesting the need to guarantee an adequate status, in particular for patients with acute or chronic infections with profound VD deficiency.…”