Abstract
ObjectivesLow 25(OH)D has been associated with dyslipidemia, insulin resistance and inflammation in both general and HIV-infected (mostly treated) populations. We investigated these associations in antiretroviral-naïve HIV-infected persons.DesignWe measured plasma 25(OH)D, metabolic, immunologic and inflammatory markers in 355 persons (204 Whites, 151 Blacks) at enrollment in the ANRS COPANA cohort.Methods25(OH)D levels were categorized <10 ng/mL (severe deficiency) and <20 ng/mL (deficiency). Statistical analyses were adjusted for sampling season, ethnicity and the interaction between season and ethnicity.Results25(OH)D insufficiency (<30 ng/mL), deficiency (<20 ng/mL) and severe deficiency (<10 ng/mL) were highly prevalent (93%, 67% and 24% of patients, respectively). Blacks had significantly lower 25(OH)D than Whites (median: 13 vs. 17 ng/mL, P<0.001), with markedly less pronounced seasonal variation. Smoking and drinking alcohol were associated with having a 25 OHD level<10 ng/mL. In patients with 25(OH)D<10 ng/mL, the proportion of persons with a CD4 count<100/mm3 was higher than in patients with 25(OH)D≥10 ng/mL (18.8% vs. 10.7%, P = 0.04). Persons with 25 OHD<10 ng/mL had higher levels of hsCRP (1.60 mg/L [IQR: 0.59–5.76] vs. 1.27 mg/L [0.58–3,39], P = 0.03) and resistin (16.81 ng/L [IQR: 13.82–25.74] vs. 11.56 ng/L [IQR: 8.87–20.46], P = 0.02), and, among Blacks only, sTNFR2 (2.92 ng/mL [2.31–4.13] vs. 2.67 ng/mL, [1.90–3.23], P = 0.04). The strength and significance of the association between CD4<100/mm3 and 25 OHD<10 ng/mL were reduced after adjustment on sTNFR1, sTNFR2, and hsCRP levels. In multivariate analysis, a CD4 count <100/mm3, resistin concentration and smoking were independently associated with 25(OH)D<10 ng/mL.ConclusionsSevere vitamin D deficiency was associated with low CD4 counts and increased markers of inflammation in ARV-naïve HIV-infected persons.
Highlights
In the general population, vitamin D deficiency, assessed by low levels of 25-hydroxy vitamin D (25(OH)D), has been associated with diverse conditions, of which many have become of concern in the HIV-infected population, such as infections, cardiovascular disease, insulin resistance and diabetes, dyslipidemia, cancer, neurocognitive impairment, frailty, renal function alteration, osteopenia/osteoporosis, and autoimmune diseases [1,2,3,4]
Severe vitamin D deficiency was associated with low CD4 counts and increased markers of inflammation in ARV-naıve HIV-infected persons
Patients who accepted to participate entered a metabolic substudy comprising an oral glucose tolerance test (OGTT), measurements of inflammatory markers, insulin and adipokines, computed tomography (CT) at the level of the L4 vertebra and dual-energy X-ray absorptiometry (DEXA) [29]. 25(OH)D was measured in plasma samples taken at enrollment from 355 patients of Black or White ethnicity
Summary
Vitamin D deficiency, assessed by low levels of 25-hydroxy vitamin D (25(OH)D), has been associated with diverse conditions, of which many have become of concern in the HIV-infected population, such as infections, cardiovascular disease, insulin resistance and diabetes, dyslipidemia, cancer, neurocognitive impairment, frailty, renal function alteration, osteopenia/osteoporosis, and autoimmune diseases [1,2,3,4]. Vitamin D deficiency has been associated with clinical and pre-clinical endpoints in HIV-infected persons: all-cause mortality during untreated [17] and treated [18,19] HIV infection, lesser CD4 cell gain on antiretroviral therapy [20,21], AIDS and non-AIDS-defining events [18,22,23], insulin resistance [24], type 2 diabetes [25], and atherosclerosis [26,27,28]. These data suggest that treated and untreated HIV-infected persons might be susceptible to the deleterious effects of vitamin D deficiency
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