HIV and AIDSTreatment

One study reported that higher serum 25(OH)D levels were associated with reduced rate of progression of HIV1.

One of the common problems encountered by those with HIV/AIDS is lower bone mass density and increased risk of osteoporosis2. Raising serum 25(OH)D levels in conjunction with calcium, magnesium, boron, vitamin C, and hydrolyzed collagen can help reduce the risk of osteoporosis3.

Vitamin D inhibits antigen presenting cell maturation and antigen presentation acting as antigen-presentation attenuator. Subsequently, the use of VDR antagonist and/or inhibitors of the vitamin D pathway enzymes could be proposed as co-adjuvants in HIV therapeutic approaches4. However, further research is likely required before this can be done.

Those being treated for HIV/AIDS with HAART can have lower serum 25(OH)D and 1,25(OH)2D levels from the treatment5. It was pointed out that cholesterol plays a key role in facilitating HIV infection6  [Nguyen and Taub, 2004]. However, lowering cholesterol levels has not been found effective in reducing viral replication, and lower cholesterol is one of the problems with HAART7. It was recently suggested that vitamin D levels be raised in order to prevent the adverse metabolic action of HAART8.

Thus, anyone who has HIV/AIDS could have their 25(OH)D levels tested and then supplement to raise levels to the 40+ ng/mL level. While there is a rule of thumb that 1000 IU/d raises serum 25(OH)D levels by 6-10 ng/mL [Heaney et al., 2003], there is a large uncertainty in this number due to genetic factors9 and other factors such as smoking10, whether vitamin D is taking with the largest meal of the day1112, and calcium intake.

Hypercalcaemia in patients with HIV infection is usually associated with specific conditions such as lymphoma and granulomatous diseases. We described a case of severe hypercalcaemia consequent to vitamin D intoxication and secondary renal failure in a HIV patient under use of tenofovir. Serum creatinine and calcium returned to near normal levels after vitamin D discontinuation, saline and furosemide administration. Some aspects of the drug-induced nephropathy are discussed1314.

It is not clear how often hypercalcemia arises in those with HIV/AIDS, so those treating such patients should familiarize themselves with the symptoms of hypercalcemia and if it develops, drop back on the vitamin D intake or production. The toxic signs of the resulting hypercalcemia included pain, conjunctivitis, anorexia, fever, chills, thirst, vomiting, and weight loss15. Some symptoms also include constipation, decreased appetite, lethargy, polyuria, dehydration and failure to thrive16

Page last edited: 09 May 2011

References

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