HIV and AIDS Vitamin D levels

 Low vitamin D levels are common among HIV and AIDS patients.

Many with HIV or AIDS have low serum 25-hydroxyvitamin D [25(OH)D] levels12. This finding has been attributed to low solar UVB irradiance, especially among urban inhabitants34 and low vitamin D production for those with dark skin.

An observational study in Tanzania found reduced transmission of HIV to infants for mothers with higher serum 25(OH)D levels5.

African-Americans have a higher fraction of their population with HIV/AIDS than European- or Asian-Americans6. One reason could be lower serum 25(OH)D levels (16 ng/ml for African-Americans vs. 26 ng/ml for white-Americans)7. However, another reason could be higher prevalence of  alipoproteinE epsilon4 (ApoE4) allele. ApoE4 increases production of cholesterol in the kidney and is associated with increased risk of HIV8. Africans have much higher prevalence of ApoE4 than Europeans or Asians9.

As vitamin D reduces the risk of many types of disease10, the inverse correlation of all cause mortality rate in this study is easy to understand.

In addition to low UVB irradiance or oral intake, use of highly active antiretroviral therapy (HAART) is associated with lower 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels and lower bone mass density (BMD) for those with HIV/AIDS. In a study in Italy:

Following WHO BMD t-score criteria, osteopenia was ascertained in >35% of all HAART groups and in 30% of naive. Only HAART patients had osteoporosis, protease inhibitors (PI) patients more frequently, significantly (p<0.03) in spine (21.7% vs 8.3%). Males, intravenous drug users and B-C stage patients have a higher risk for low bone mass. Mean t-score was significantly lower in both spine and femur; 1,25(OH)2D was significantly lower in all HIV groups than controls, PI patients having the lowest values positively correlating with BMD, and it decreased further in 27 non selected monitored patients continuing on HAART. Parathyroid hormone (PTH) was higher and Ca lower in HAART patients than controls but not significantly, PTH negatively correlating with BMD11

Page last edited: 14 May 2011

References

  1. Bang, U. C. Shakar, S. A. Hitz, M. F. Jespersen, M. S. Andersen, O. Nielsen, S. D. Jensen, J. E. Deficiency of 25-hydroxyvitamin D in male HIV-positive patients: a descriptive cross-sectional study. Scand J Infect Dis. 2010 Apr; 42 (4): 306-10.
  2. Mueller, N. J. Fux, C. A. Ledergerber, B. Elzi, L. Schmid, P. Dang, T. Magenta, L. Calmy, A. Vergopoulos, A. Bischoff-Ferrari, H. A. High prevalence of severe vitamin D deficiency in combined antiretroviral therapy-naive and successfully treated Swiss HIV patients. AIDS. 2010 May 15; 24 (8): 1127-34.
  3. Stephensen, C. B. Marquis, G. S. Kruzich, L. A. Douglas, S. D. Aldrovandi, G. M. Wilson, C. M. Vitamin D status in adolescents and young adults with HIV infection. Am J Clin Nutr. 2006 May; 83 (5): 1135-41.
  4. Wasserman, P. Rubin, D. S. Highly prevalent vitamin D deficiency and insufficiency in an urban cohort of HIV-infected men under care. AIDS Patient Care STDS. 2010 Apr; 24 (4): 223-7.
  5. Mehta, S. Hunter, D. J. Mugusi, F. M. Spiegelman, D. Manji, K. P. Giovannucci, E. L. Hertzmark, E. Msamanga, G. I. Fawzi, W. W. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis. 2009 Oct 1; 200 (7): 1022-30.
  6. Oramasionwu, C. U. Brown, C. M. Ryan, L. Lawson, K. A. Hunter, J. M. Frei, C. R. HIV/AIDS disparities: the mounting epidemic plaguing US blacks. J Natl Med Assoc. 2009 Dec; 101 (12): 1196-204.
  7. Ginde, A. A. Liu, M. C. Camargo, C. A., Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009 Mar 23; 169 (6): 626-32.
  8. Burt, T. D. Agan, B. K. Marconi, V. C. He, W. Kulkarni, H. Mold, J. E. Cavrois, M. Huang, Y. Mahley, R. W. Dolan, M. J. McCune, J. M. Ahuja, S. K. Apolipoprotein (apo) E4 enhances HIV-1 cell entry in vitro, and the APOE epsilon4/epsilon4 genotype accelerates HIV disease progression. Proc Natl Acad Sci U S A. 2008 Jun 24; 105 (25): 8718-23.
  9. Grant, W. B. A multicountry ecological study of risk-modifying factors for prostate cancer: apolipoprotein E epsilon4 as a risk factor and cereals as a risk reduction factor. Anticancer Res. 2010 Jan; 30 (1): 189-99.
  10. Holick, M. F. Vitamin D deficiency. N Engl J Med. 2007 Jul 19; 357 (3): 266-81.
  11. Madeddu, G. Spanu, A. Solinas, P. Calia, G. M. Lovigu, C. Chessa, F. Mannazzu, M. Falchi, A. Mura, M. S. Bone mass loss and vitamin D metabolism impairment in HIV patients receiving highly active antiretroviral therapy. Q J Nucl Med Mol Imaging. 2004 Mar; 48 (1): 39-48.