Vitamin D insufficiency is common in children infected with HIV

Abstract

Kakalia et al in Toronto conducted a well-conceived, well-implemented, and well-analyzed prospective randomized 6-month study of vitamin D status and effect of supplementation in children infected with HIV. In this group of clinically stable, average-aged 10-year-old children, with relatively preserved immune function, normal CD4, who were receiving predominantly antiretroviral therapy, a striking 85% had vitamin D insufficiency or deficiency (serum 25[OH]D level <75 nmol/L).Compared with the group randomized to no supplementation, groups who were given 800 IU/day or 1600 IU/day (in once a week doses) had significant increases in serum levels of 25(OH)D. Children given 1600 IU/day achieved higher mean increase in 25(OH)D than those treated with the lower dose, yet only 67% of these highly supplemented children achieved vitamin D sufficiency within 6 months of therapy. Even supplementation that achieved vitamin D sufficiency was not associated with an increase in CD4 count or percentage in the patients studied in this trial whose CD4 levels were in the normal range at baseline. Despite failure to document an immunologic effect, the implications of vitamin D supplementation for maintenance of bone health are clear. The Institute of Medicine's recommended daily vitamin D requirement of 600 IU would likely be inadequate in children infected with HIV, regardless of cutoff level used to define vitamin D sufficiency.Further research is needed in children infected with HIV, including study of optimal dosing of vitamin D supplementation (both for bone health and immunologic benefit), the impact of antiretroviral therapy on vitamin D homeostasis and the importance of serum and intracellular 1,25(OH)D levels on CD4 counts.Article page 951▶ Kakalia et al in Toronto conducted a well-conceived, well-implemented, and well-analyzed prospective randomized 6-month study of vitamin D status and effect of supplementation in children infected with HIV. In this group of clinically stable, average-aged 10-year-old children, with relatively preserved immune function, normal CD4, who were receiving predominantly antiretroviral therapy, a striking 85% had vitamin D insufficiency or deficiency (serum 25[OH]D level <75 nmol/L). Compared with the group randomized to no supplementation, groups who were given 800 IU/day or 1600 IU/day (in once a week doses) had significant increases in serum levels of 25(OH)D. Children given 1600 IU/day achieved higher mean increase in 25(OH)D than those treated with the lower dose, yet only 67% of these highly supplemented children achieved vitamin D sufficiency within 6 months of therapy. Even supplementation that achieved vitamin D sufficiency was not associated with an increase in CD4 count or percentage in the patients studied in this trial whose CD4 levels were in the normal range at baseline. Despite failure to document an immunologic effect, the implications of vitamin D supplementation for maintenance of bone health are clear. The Institute of Medicine's recommended daily vitamin D requirement of 600 IU would likely be inadequate in children infected with HIV, regardless of cutoff level used to define vitamin D sufficiency. Further research is needed in children infected with HIV, including study of optimal dosing of vitamin D supplementation (both for bone health and immunologic benefit), the impact of antiretroviral therapy on vitamin D homeostasis and the importance of serum and intracellular 1,25(OH)D levels on CD4 counts. Article page 951▶ Vitamin D Supplementation and CD4 Count in Children Infected with Human Immunodeficiency VirusThe Journal of PediatricsVol. 159Issue 6PreviewTo evaluate, in a randomized fashion, the impact of vitamin D supplementation on CD4 count and measures of vitamin D homeostasis in children infected with human immunodeficiency virus (HIV). Full-Text PDF