Success of Standard Dose Vitamin D Supplementation in Treated Human Immunodeficiency Virus Infection
Open Forum Infect Dis (Spring 2015) 2 (2): doi: 10.1093/ofid/ofv068
Jordan E. Lake1, Risa M. Hoffman1, Chi-Hong Tseng1, Holly M. Wilhalme1, John S. Adams2 and Judith S. Currier1
1Department of Medicine
2Department of Orthopaedic Surgery, University of California, Los Angeles
Correspondence: Jordan E. Lake, MD, MSc, UCLA Department of Medicine, Center for Clinical AIDS Research and Education, 11075 Santa Monica Blvd., Ste. 100, Los Angeles, CA 90025 (firstname.lastname@example.org).
Presented in part: 13th International Workshop on Adverse Drug Reactions and Co-Morbidities in Rome, Italy.
Background. Vitamin D insufficiency is prevalent in human immunodeficiency virus-positive (HIV+) persons. Human immunodeficiency virus and antiretroviral therapy (ART) may create unique risk factors, and the optimal vitamin D repletion and maintenance regimen in HIV+ persons remains unclear.
Methods. Human immunodeficiency virus-positive adults on suppressive ART underwent routine serum 25-hydroxyvitamin D (25OHD) screening. Persons with vitamin D insufficiency (25OHD <30 ng/mL) received open-label, oral vitamin D3 50 000 international units (IU) twice weekly for 5 weeks, then 2000 IU daily to complete 12 weeks. We predicted 70% (95% confidence interval, 60%–80%) repletion to 25OHD ≥30 ng/mL compared with 85% among historical HIV-negative controls. Eighty participants provided 91% power to detect this difference. Ability to maintain 25OHD ≥30 ng/mL after 24 weeks was also assessed.
Results. Baseline characteristics were similar between the 82 vitamin D insufficient and 40 sufficient persons enrolled: 95% male, 60% white, 88% nonsmokers, median age 49 years, body mass index 26 kg/m2, and CD4+ T lymphocyte count 520 cells/mm3. After 12 weeks, 81% (66 of 82) of insufficient persons achieved 25OHD ≥30 ng/mL (P = .32 vs historical controls), with only older age (odds ratio [OR] = 1.06; P = .06), higher baseline 25OHD (OR = 1.14; P < .01), white race (OR = 3.39; P = .04), and current smoking (OR = 0.25; P = .06) associated with successful repletion. After 24 weeks, 73% (48 of 66) maintained 25OHD ≥30 ng/mL, with tenofovir (OR = 5.00; P = .01) and abacavir use (OR = 0.23; P = .02) associated with success and failure, respectively, to maintain 25OHD levels.
Conclusions. The 25OHD repletion rates were comparable between HIV+ adults on suppressive ART and historical HIV-negative controls, indicating that successful oral repletion can be achieved in this population.
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