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Vitamin D deficiency may impair CD4 recovery among Women's Interagency HIV Study (WIHS) participants on HAART
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Reported by Jules Levin CROI 2012 March 5-8 Seattle WA
M. AZIZ1,2, O. ADEYEMI 1,2 J. ORSI 2, B. LIVAK 2, A. FRENCH 1,2, M. GLESBY 3, A. SHARMA 4, M. YOUNG 5, M. VILLACRES 6, P. TIEN 7, E. GOLUB 8, M. COHEN 1,2 1Rush Univ. Med. Ctr., Chicago, IL, 2John H Stroger Hosp., Chicago, IL, 3Weill Med. Coll. of Cornell, New York, NY, 4SUNY Downstate Med. Ctr., Brooklyn, NY, 5Georgetown Univ. Med. Ctr., Washington, DC, 6Univ. of Southern California, Los Angeles, CA, 7Univ. of California, SF, San Fransisco, CA, 8Johns Hopkins Univ., Baltimore, MD
ABSTRACT
Background: A recent study reported an association between vitamin D (25OH-D) deficiency and CD4 recovery on HAART and we sought to explore this in the WIHS.
Methods: 260 HIV-infected women with a pre-HAART visit and CD4 6, 12 and 24 months after HAART initiation were included. 25OH-D levels measured at pre-HAART visit were defined as deficient (<20 ng/ml) or insufficient (20-30 ng/ml). CD4 recovery was defined as increases of >50 cells, >100 cells and >200 cells at 6, 12, and 24 months, respectively. Univariate statistics were calculated using Chi-Square and Mantel-Haenzel Chi-Square for categorical variables and the non-parametric Kruskal-Wallis test for continuous variables. Multivariate analyses were calculated using logistic regression. All analyses were conducted using SAS v9.2
Results: 58% were deficient and 31% were insufficient. African-American women were more likely deficient than Hispanic or White women (73% vs 43% and 27% respectively, p<0.0001). Patients had similar CD4 nadir and baseline viral loads. Deficient patients were older (p=0.04), and had higher median BMI (p=0.03) and were more likely to be started on a non-PI based ART regimen (p=0.02).
In multivariate analysis, undetectable HIV RNA on HAART was the strongest predictor of CD4 recovery (OR=7.21, 95% CI: 3.3-15.76 at 6 months; OR=5.92, 95%CI: 2.89-12.11 at 12 months; OR=6.16, 95%CI: 2.84-13.39 at 24 months). 25OH-D insufficiency (OR= 0.20, 95% CI 0.06-0.70) and 25OH-D deficiency (OR=0.27 95% CI 0.08-0.94) was negatively associated with CD4 recovery at 24 months after start of HAART. There was no association at earlier time points, e.g., 6 and 12 months following HAART initiation.
Conclusions: Vitamin D deficiency is negatively associated with late CD4 recovery on HAART in this cohort. The mechanism of this association and the effect of vitamin D supplementation on late CD4 recovery could be explained by the late production of naïve CD4 cells during immune reconstitution; this merits further exploration
Figure 1. Vitamin D status (normal versus insufficient) and CD4 reconstitution before and after HAART initiation. Both Vitamin D normal and insufficient start with an average CD4 of about 100 cells/ml pre-HAART initiation.
References
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