TY - JOUR
T1 - 25-hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings
AU - Havers, Fiona
AU - Smeaton, Laura
AU - Gupte, Nikhil
AU - Detrick, Barbara
AU - Bollinger, Robert C.
AU - Hakim, James
AU - Kumarasamy, Nagalingeswaran
AU - Andrade, Adriana
AU - Christian, Parul
AU - Lama, Javier R.
AU - Campbell, Thomas B.
AU - Gupta, Amita
N1 - Funding Information:
Financial support. This work was supported by the AIDS Clinical Trials Group and the US National Institute of Allergy and Infectious Diseases [AI68636, AI069450]; and the US National Institutes of Health [R01 AI45462 to A. G., T32 AI007291 to F. H.]. This work was also supported in part by Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, and GlaxoSmithKline. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.
PY - 2014/7/15
Y1 - 2014/7/15
N2 - Background. Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking. Methods. A case-cohort study (N = 411) was nested within a randomized cART trial of 1571 cART-naive adults in 8 resource-limited settings and the United States. The primary outcome (WHO stage 3/4 disease or death within 96 weeks of cART initiation) was met by 192 cases, and 152 and 29 cases met secondary outcomes of virologic and immunologic failure. We studied prevalence and risk factors for baseline low 25(OH)D (<32 ng/mL) and examined associated outcomes using proportional hazard models. Results. Low 25(OH)D prevalence was 49% and ranged from 27% in Brazil to 78% in Thailand. Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09-4.18) and virologic failure (aHR 2.42; 95% CI, 1.33-4.41). Conclusions. Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure. Studies examining the potential benefit of vitamin D supplementation among HIV patients initiating cART are warranted.
AB - Background. Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking. Methods. A case-cohort study (N = 411) was nested within a randomized cART trial of 1571 cART-naive adults in 8 resource-limited settings and the United States. The primary outcome (WHO stage 3/4 disease or death within 96 weeks of cART initiation) was met by 192 cases, and 152 and 29 cases met secondary outcomes of virologic and immunologic failure. We studied prevalence and risk factors for baseline low 25(OH)D (<32 ng/mL) and examined associated outcomes using proportional hazard models. Results. Low 25(OH)D prevalence was 49% and ranged from 27% in Brazil to 78% in Thailand. Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09-4.18) and virologic failure (aHR 2.42; 95% CI, 1.33-4.41). Conclusions. Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure. Studies examining the potential benefit of vitamin D supplementation among HIV patients initiating cART are warranted.
KW - Asia
UR - http://www.scopus.com/inward/record.url?scp=84903955595&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84903955595&partnerID=8YFLogxK
U2 - 10.1093/infdis/jiu259
DO - 10.1093/infdis/jiu259
M3 - Article
C2 - 24799602
AN - SCOPUS:84903955595
SN - 0022-1899
VL - 210
SP - 244
EP - 253
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 2
ER -