Leah Shepherd1, Jean-Claude Souberbielle2, Jean-Philippe Bastard3, Soraya Fellahi3, Jaqueline Capeau3, Joanne Reekie4, Peter Reiss5, Anders Blaxhult6, Markus Bickel7, Clifford Leen8, Ole Kirk9, Jens D Lundgren9, Amanda Mocroft1, Jean-Paul Viard10. 1. Department of Infection and Population Health, University College London Medical School, London, United Kingdom. 2. Service d'Explorations Fonctionnelles, Hôpital Necker, Paris, France. 3. Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France. 4. Department of Infection and Population Health, University College London Medical School, London, United Kingdom The Kirby Institute University of New South Wales, Sydney, New South Wales, Australia. 5. Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands. 6. Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden. 7. HIVCENTER Haus 68, Frankfurt, Germany. 8. Edinburgh Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom Edinburgh Infectious Diseases Edinburgh University, Edinburgh, United Kingdom. 9. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Centre for Viral Diseases, Rigshospitalet, Copenhagen, Denmark. 10. Centre de Diagnostic et de Thérapeutique Hôtel-Dieu, APHP, and EA 3620, Université Paris Descartes, Paris, France.
Abstract
BACKGROUND: Low 25-hydroxyvitamin D (25(OH)D) has been associated with inflammation, human immunodeficiency virus (HIV) disease progression, and death. We aimed to identify the prognostic value of 25(OH)D for AIDS, non-AIDS-defining events and death, and its association with immunological/inflammatory markers. METHODS: Prospective 1-1 case-control study nested within the EuroSIDA cohort. Matched cases and controls for AIDS (n = 50 matched pairs), non-AIDS-defining (n = 63) events and death (n = 41), with plasma samples during follow-up were selected. Conditional logistic regression models investigated associations between 25(OH)D levels and annual 25(OH)D change and the probability of events. Mixed models investigated relationships between 25(OH)D levels and immunological/inflammatory markers. RESULTS: In sum, 250 patients were included. Median time between first and last sample and last sample and event was 44.6(interquartile range [IQR]: 22.7-72.3) and 3.1(IQR: 1.4-6.4) months. Odds of death decreased by 46.0%(95% confidence interval [CI], 2.0-70.0, P = .04) for a 2-fold increase in latest 25(OH)D level. There was no association between 25(OH)D and the occurrence of AIDS or non-AIDS-defining events (P > .05). In patients with current 25(OH)D <10 ng/mL, hsIL-6 concentration increased by 4.7%(95% CI, .2,9.4, P = .04) annually after adjustment for immunological/inflammatory markers, and no change in hsCRP rate was observed (P = .76). CONCLUSIONS: Low Vitamin D predicts short term mortality in HIV-positive persons. Effectiveness of vitamin D supplementation on inflammation and patient outcomes should be investigated.
BACKGROUND: Low 25-hydroxyvitamin D (25(OH)D) has been associated with inflammation, human immunodeficiency virus (HIV) disease progression, and death. We aimed to identify the prognostic value of 25(OH)D for AIDS, non-AIDS-defining events and death, and its association with immunological/inflammatory markers. METHODS: Prospective 1-1 case-control study nested within the EuroSIDA cohort. Matched cases and controls for AIDS (n = 50 matched pairs), non-AIDS-defining (n = 63) events and death (n = 41), with plasma samples during follow-up were selected. Conditional logistic regression models investigated associations between 25(OH)D levels and annual 25(OH)D change and the probability of events. Mixed models investigated relationships between 25(OH)D levels and immunological/inflammatory markers. RESULTS: In sum, 250 patients were included. Median time between first and last sample and last sample and event was 44.6(interquartile range [IQR]: 22.7-72.3) and 3.1(IQR: 1.4-6.4) months. Odds of death decreased by 46.0%(95% confidence interval [CI], 2.0-70.0, P = .04) for a 2-fold increase in latest 25(OH)D level. There was no association between 25(OH)D and the occurrence of AIDS or non-AIDS-defining events (P > .05). In patients with current 25(OH)D <10 ng/mL, hsIL-6 concentration increased by 4.7%(95% CI, .2,9.4, P = .04) annually after adjustment for immunological/inflammatory markers, and no change in hsCRP rate was observed (P = .76). CONCLUSIONS: Low Vitamin D predicts short term mortality in HIV-positive persons. Effectiveness of vitamin D supplementation on inflammation and patient outcomes should be investigated.
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