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HIV patients helped by monthly 120,000 IU of Vitamin D – RCT Oct 2017

Vitamin D supplementation decreases immune activation and exhaustion in HIV-1-infected youth.

Antivir Ther. 2017 Oct 10. doi: 10.3851/IMP3199.

VitaminDWiki


Eckard AR1,2, O'Riordan MA3, Rosebush JC2, Lee ST2, Habib JG2, Ruff JH2, Labbato D3, Daniels JE2, Uribe-Leitz M2, Tangpricha V2, Chahroudi A2, McComsey GA3.
1 Medical University of South Carolina, Charleston, SC, USA.
2 Emory University School of Medicine, Atlanta, GA, USA.
3 Rainbow Babies & Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, USA.

BACKGROUND:
Heightened immune activation and exhaustion drive HIV disease progression and co-morbidities. Vitamin D has pleiotropic immunomodulatory effects, but little is known about the effects of supplementation in HIV. Our study investigates changes in immune activation and exhaustion markers after 12 months of supplementation in virologically-suppressed HIV-infected youth with vitamin D insufficiency.

METHODS:
This is a randomized, active-control, double-blind trial investigating with 3 different vitamin D3 doses [18,000 (standard/active-control dose), 60,000 (moderate dose) and 120,000 IU/monthly (high dose)] in 8-26 year old HIV-infected youth on combination antiretroviral therapy with baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations ≤30 ng/mL. Only subjects (N=51) who maintained an undetectable HIV-1 RNA over the 12-month study period were included in this analysis.

RESULTS:
Baseline serum 25(OH)D concentrations and immune activation/exhaustion markers were not different between groups. By 12 months, 25(OH)D increased significantly within each dosing group with the greatest increase and most sustained concentrations ≥30 ng/mL in the high-dose group. Overall, all measured markers decreased with CD4 activation (CD4+CD38+HLA-DR+), CD8 activation (CD8+CD38+HLA-DR+), CD4 exhaustion (CD4+CD38+HLA-DR+PD1+), and inflammatory monocytes (CD14+CD16+) reaching statistical significance. When analyzed separately, there were no significant decreases in the moderate- or standard-dose groups, but CD4 and CD8 activation and inflammatory monocytes decreased significantly in the high-dose group.

CONCLUSIONS:
Vitamin D supplementation decreased markers of T-cell activation/exhaustion and monocyte activation in HIV-infected youth, with subjects given the highest dose (120,000 IU/month) showing the greatest decreases. These data suggest that high-dose vitamin D supplementation may attenuate immune activation and exhaustion and serve as adjuvant therapy to antiretroviral therapy in HIV.

PMID: 28994661 DOI: 10.3851/IMP31990
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