Overview HIV and vitamin D

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• HIV interactions with low Vitamin D - May 2013
• 7000 IU of vitamin D restored most HIV youths to above 32 ng - RCT March 2014
• HIV patients having EFC therapy were 3X more likely to have low vitamin D levels – Sept 2012
• Vitamin D deficiency in HIV-infected and un-infected women in the US – April 2011
• HIV – recommend 100,000 IU vitamin D monthly to get levels 30 ng – May 2013
• Blacks with HIV were 3.5X more likely to be vitamin D deficient than whites – May 2012
• HIV interactions with low Vitamin D - May 2013
• HIV – lower vitamin D if Black, higher if PI monotherapy – Oct 2013
• All items in category Inflammation and Vitamin D 171 items
• All items in category Virus and Vitamin D 1342 items

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HIV category contains

45 HIV items   see also: Overview HIV and vitamin D   Immunity category: 262 items

Pregnant women in HIV therapy adding Vitamin D had 3X fewer deaths - RCT April 2022
HIV treatment augmented by high-dose vitamin D, daily or weekly – Dec 2021
Low vitamin D with HIV increases risk of infections – TB by 3.5X, CMV by 10.1X – Aug 2020
HIV therapy reduces Vitamin D levels, supplementation helps - Nov 2019
Cognitive problems 2X more likely if HIV and low vitamin D – June 2019
Use of Tenofovir disoproxil fumarate (Hepatitis-B, AIDS) requires more vitamin D – Sept 2018
Vertebral fractures 9X more likely in HIV patients having low vitamin D – Dec 2017
HIV patients helped by monthly 120,000 IU of Vitamin D – RCT Oct 2017
Those with HIV who doubled their vitamin D levels reduced their chance of death by 47 percent – Oct 2013
A gut-friendly form of vitamin D should be used for those with HIV and gut problems
   Alternately, just use 2X to 3X more vitamin D than for a person who has a good gut
3X more African girls and women have HIV than African males Washington Post Dec 2023
  Note: Many women have lower vitamin D levels than men due to hormones and not being outdoors as much
  In addition, dark-skinned women often avoid the sun due to a desire to have a lighter skin shade

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Suggest 100,000 IU monthly to fight HIV (with chart)- 2012

 Download the PDF from Vitamin D Life

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HIV youths on antiretroviral therapy helped by monthly 120,000 IU 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. [Epub ahead of print]
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 U. School of Med, 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/IMP3199

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PubMed HIV or AIDS and "Vitamin D" in title) 262 items - Sept 2021

• Severe Vitamin D Deficiency in Human Immunodeficiency Virus-Infected Pregnant Women is Associated with Preterm Birth
  Preterm birth 4.7 X more likely if HIV and low vitamin D. Oct 2016
• Anti-Inflammatory and Antimicrobial Actions of Vitamin D in Combating TB/HIV Summer 2014
  PDF is attached at the bottom of this page
• High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs Sept 2012
• HIV Patients on antiretroviral therapy are at higher risk of vitamin D deficiency PubMed May 2012
• Immunophenotype of Vitamin D Receptor Polymorphism Associated to Risk of HIV-1 Infection and Rate of Disease Progression Sept 2010
• Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women June 2010 -CONCLUSIONS: In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race...
• Highly prevalent vitamin D deficiency and insufficiency in an urban cohort of HIV-infected men under care
• Vitamin D time profile based on the contribution of non-genetic and genetic factors in HIV-infected individuals of European ancestry July 2014
  300,000 IU twice a year keep patients within the range of 20-40 ng of vitamin D
• Vitamin D Status of HIV-Infected Women and Its Association with HIV Disease Progression, Anemia, and Mortality - 2010 PDF is attached at the bottom of this page

Conclusion from paper above
Low vitamin D status (serum 25-hydroxyvitamin D<32ng/mL) was significantly associated with progression to WHO HIV disease stage III or greater in multivariate models (incidence rate ratio [RR]: 1.25; 95% confidence intervals [CI]: 1.05, 1.50).
No significant relationship was observed between vitamin D status and T-cell counts during follow-up. Women with low vitamin D status had 46% higher risk of developing severe anemia during follow-up, compared to women with adequate vitamin D levels (RR: 1.46; 95% CI: 1.09, 1.96). Women in the highest vitamin D quintile had a 42% lower risk of all-cause mortality, compared to the lowest quintile (RR: 0.58; 95% CI: 0.40, 0.84).
Vitamin D status had a protective association with HIV disease progression, all-cause mortality, and development of anemia during follow-up in HIV-infected women.
If confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to prolonging the time to initiation of antiretroviral therapy in HIV-infected patients, particularly in resource-limited settings.

Vitamin D Cure book talks about HIV and vitamin D deficiency

49 Intervention HIV trials using vitamin D as of April 2021

Intervention HIV trials

• 7,000 IU
• 7,000 IU
• 4,000 IU daily average (120,000 IU/month)
• 3,000 IU

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HIV vicious circles with vitamin D deficiency – Aug 2012

Review of Metabolic, Immunologic, and Virologic Consequences of Suboptimal Vitamin D Levels in HIV Infection
AIDS Patient Care and STDs, Online Ahead of Print: August 3, 2012
Allen T. Griffin atgrif01 at louisville.edu, M.D., and Forest W. Arnold, D.O., M.Sc.
School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky.

Low 25-hydroxyvitamin D levels are common in the general and HIV-infected populations alike. Defined as levels less than 30?ng/mL, suboptimal vitamin D is known to afflict over 70% of representative samples from each group in resource-rich countries with even greater prevalence in resource-poor regions of the world.

In both those with and without HIV, dark skin, low vitamin D intake, exiguous exposure to sunlight, and season act as risk factors for suboptimal vitamin D levels.

In those infected with HIV, antiretroviral therapy, particularly non-nucleoside reverse transcriptase inhibitors (NNRTIs), increase risk for low vitamin D as well.

Furthermore, metabolic aberrations, including obesity and hyperlipidemia, and miscellaneous risk factors, such as advanced AIDS and substance abuse, have been linked to suboptimal vitamin D in those with HIV.

While the skeletal and cardiovascular systems of HIV patients may be adversely impacted as a result of low levels, recent data have also linked low vitamin D to decreased CD4 counts, higher viral loads, and to critical end points including progression to AIDS events and death. More research is needed to confirm these potential consequences of low vitamin D in those with HIV and to discern the benefits of routine screening for and treatment of low vitamin D in this population.

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HIV susceptability not associated with Vitamin D

Vitamin D Levels, Natural H1N1 Infection and Response to H1N1 Vaccine among HIV-Infected Individuals
J AIDS Clinic Res 2012, 3:5 http://dx.doi.org/10.4172/2155-6113.1000152
Florence Momplaisir 1, Ian Frank 2, WA Meyer III 3, Deborah Kim 2, Rosemary Kappes 2 and Pablo Tebas 2
1 Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
2 Division of Infectious Diseases, AIDS Clinical Trials Unit, Center for AIDS Research, University of Pennsylvania School of Medicine, Philadelphia, USA
3 Quest Diagnostics, Baltimore, Maryland, USA

Background: Beyond its role in calcium homeostasis, vitamin D plays a critical role in immunological responses to pathogens. We evaluated the relationship between 25-OH vitamin D levels and susceptibility to natural H1N1 infection and H1N1 vaccine responses in HIV infected individuals.

Methods: This was a sub study of an H1N1 vaccine trial conducted at the University of Pennsylvania in 2009/10. We compared the 25-OH vitamin D levels among individuals with and without baseline evidence of prior H1N1 infection and between vaccine responders and non-responders.

Results: 120 participants enrolled in the trial, 71% male, 68% African American, median age 46 years.
The majority had controlled HIV disease.
At baseline, 86% had 25-OH vitamin D levels < 30 ng/ml and 54% had levels < 20 ng/ml.
Thirty participants (25%) had evidence of prior H1N1 exposure.
There was no difference in mean 25-OH vitamin D levels among patients with or without prior natural H1N1 infection (21 ng/ml vs 20 ng/ml, p=0.72).
Among participants without previous H1N1 exposure, only 61% developed protective antibody titers following vaccination.
25-OH vitamin D levels were similar between vaccine responders (20 ng/ml) and non-responders (20 ng/ml) (p=0.83).

Conclusion: Although 25-OH vitamin D deficiency was very common among HIV-infected individuals, it was not associated with natural susceptibility to H1N1 or to vaccine responses.

PDF attached at the bottom of this page

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Serum 25-hydroxyvitamin D levels and C-reactive protein in persons with HIV infection.

AIDS Res Hum Retroviruses. 2012 Sep 24.
Poudel-Tandukar K, Poudel KC, Jimba M, Kobayashi J, Johnson CA, Palmer PH.
Waseda University, Waseda Institute for Advanced Study, 1-6-1 Nishi-waseda, Shinjuku-ku, Tokyo, Japan, 1698050; kkpoudel at hotmail.com.

Human Immunodeficiency Virus (HIV) infection has been frequently associated with vitamin D deficiency as well as chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and high-sensitivity C-reactive protein (CRP) in a cohort of HIV-positive people. A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 16 to 60 years residing in the Kathmandu Valley, Nepal. Serum high-sensitivity CRP concentrations and serum 25(OH)D levels were measured by the latex agglutination nephelometry method and the competitive protein-binding assay, respectively. The relationship between serum CRP concentrations and 25(OH)D serum level were assessed using multiple logistic regression analysis with adjustment of potential cardiovascular and HIV-related factors.
The proportion of participants with 25(OH)D serum level of <20ng/mL, 20-30ng/mL, and >30ng/mL were 83.2%, 15.5%, and 1.3%, respectively.
The mean 25(OH)D serum level in men and women were 15.3ng/mL and 14.4ng/mL, respectively.

Participants with 25(OH)D serum level of <20ng/mL had a 3.2-fold higher odds of high CRP (>3 mg/L) compared to those with 25(OH)D serum level of >20ng/mL (p=0.005). Men and women with 25(OH)D serum level of <20ng/mL had 3.2 and 2.7-fold higher odds of high CRP (>3 mg/L), respectively, compared to those with 25(OH)D serum level of >20ng/mL. The relationships remained significant only in men (p=0.02) but not in women (p=0.27). A risk of having high level of inflammation (CRP >3 mg/L) may be high among HIV-positive men and women with 25(OH)D serum level of <20 ng/mL.

PMID: 23003113

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Vitamin D Life summary for HIV in Nepal (paper above)

• 83% < 20 ng of vitamin D, 3.2X more likely to have high CRP
• 99% < 30 ng of vitamin D

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Study suggests vitamin D activates TLR8 receptors which recognise and fight HIV

Attached at the bottom of this page (31-HIV)

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HIV with low vitamin D = 2X more likely to die - May 2014

25-Hydroxyvitamin D Insufficiency and Deficiency is Associated with HIV Disease Progression and Virological Failure Post-Antiretroviral Therapy Initiation in Diverse Multinational Settings.
J Infect Dis. 2014 May 5. [Epub ahead of print]
Havers F1, Smeaton L, Gupte N, Detrick B, Bollinger R, Hakim J, Kumarasamy N, Andrade A, Christian P, Lama JR, Campbell TB, Gupta A; for the ACTG PEARLS and NWCS 319 Study Teams.
Author information
1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Dr. Havers is now with the US Centers for Disease Control and Prevention, Atlanta, GA, USA, 30333.

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 1,571 cART-naïve adults in 8 resource-limited settings and the US. 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 BMI, winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of HIV progression and death (adjusted hazard ratio (aHR) 2.13; 95% 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.
PMID: 24799602

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Vitamin D and HIV Infection: A Systematic Review - March 2014

The Human Immunodeficiency Virus (HIV) infects human T cells, causing a disease that progressively leads to a dramatic deterioration of the immune function. The Acquired Immunodeficiency Syndrome (AIDS) is present when CD4+ cell count is below 200 cells/mm3 or the patient has an opportunist infection, such as esophageal candidiasis or Pneumocystis pneumonia. Since life expectancy of HIV-infected individuals has increased, mostly as a result of advances in diagnosis and treatment, they are more willing to develop long-term chronic complications, some of which have been associated with vitamin D deficiency.
 Download the PDF from Vitamin D Life.

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HIV - 4,000 and 7,000 IU Vitamin D were safe and effective - Feb 2015

Vitamin D₃ supplementation in Batswana children and adults with HIV: a pilot double blind randomized controlled trial.
PLoS One. 2015 Feb 23;10(2):e0117123. doi: 10.1371/journal.pone.0117123. eCollection 2015.
Steenhoff AP1, Schall JI2, Samuel J2, Seme B3, Marape M4, Ratshaa B3, Goercke I3, Tolle M4, Nnyepi MS5, Mazhani L6, Zemel BS7, Rutstein RM8, Stallings VA7.

Vitamin D Response varied with HIV ART being used

OBJECTIVES:
Since vitamin D insufficiency is common worldwide in people with HIV, we explored safety and efficacy of high dose cholecalciferol (D₃) in Botswana, and evaluated potential modifiers of serum 25 hydroxy vitamin D change (Δ25D).

DESIGN:
Prospective randomized double-blind 12-week pilot trial of subjects ages 5.0-50.9 years.

METHODS:
Sixty subjects randomized within five age groups to either 4000 or 7000 IU per day of D₃ and evaluated for vitamin D, parathyroid hormone, HIV, safety and growth status. Efficacy was defined as serum 25 hydroxy vitamin D (25D) ≥32 ng/mL, and safety as no simultaneous elevation of serum calcium and 25D. Also assessed were HIV plasma viral RNA viral load (VL), CD4%, anti-retroviral therapy (ART) regime, and height-adjusted (HAZ), weight-adjusted (WAZ) and Body Mass Index (BMIZ) Z scores.

RESULTS:
Subjects were 50% male, age (mean±SD) 19.5±11.8 years, CD4% 31.8±10.4, with baseline VL log₁₀ range of <1.4 to 3.8 and VL detectable (>1.4) in 22%. From baseline to 12 weeks, 25D increased from 36±9 ng/ml to 56±18 ng/ml (p<0.0001) and 68% and 90% had 25D ≥32 ng/ml, respectively (p = 0.02). Δ25D was similar by dose. No subjects had simultaneously increased serum calcium and 25D. WAZ and BMIZ improved by 12 weeks (p<0.04). HAZ and CD4% increased and VL decreased in the 7000 IU/d group (p<0.04). Younger (5-13y) and older (30-50y) subjects had greater Δ25D than those 14-29y (26±17 and 28±12 vs. 11±11 ng/ml, respectively, p≤0.001). Δ25D was higher with efavirenz or nevirapine compared to protease inhibitor based treatment (22±12, 27±17, vs. 13±10, respectively, p≤0.03).

CONCLUSIONS:
In a pilot study in Botswana, 12-week high dose D₃ supplementation was safe and improved vitamin D, growth and HIV status; age and ART regimen were significant effect modifiers.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02189902.
PMID: 25706751

 Download the PDF from Vitamin D Life

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HIV while pregnant associated with 12% HIGHER vitamin D - Dec 2018

Maternal plasma vitamin D levels and associated determinants in late pregnancy in Harare, Zimbabwe: a cross-sectional study
BMC Pregnancy and Childbirth, December 2019, 19:218
 Download the PDF from Vitamin D Life

Background
The importance of vitamin D in bone health and calcium homeostasis has been well documented. However, emerging evidence supports the role of vitamin D beyond its recognised traditional roles. In pregnancy, vitamin D levels are crucial in sustaining both the maternal stores and optimal growth of the foetus. In Southern Africa, there is paucity of data on vitamin D in pregnancy and related outcomes. To expand this body of knowledge, we assessed vitamin D levels in late pregnancy and (if any) associated maternal determinants in Harare, Zimbabwe.

Methods
Study participants comprised of 138 pregnant Zimbabwean women in their third trimester. These were stratified by HIV status; sampling median (IQR) gestation for HIV negative study participants was 34 weeks (26–41) and 31 weeks (20–40) in the HIV positive participants.

Maternal plasma 25 hydroxyvitamin (OH) Dlevels were measured using the ClinPrepHigh Pressure Liquid Chromatography (HPLC) kit. Statistical analysis was carried out using the STATA statistical package version 13. A p-value of < 0.05 was considered to be statistically significant.

Results
HIV infected participants had significantly higher mean 25 (OH) D concentration (112 ± 33.4 nmol/L) compared to the HIV uninfected (100 ± 27.1 nmol/L), p = 0.032.Participants whose samples were collected during summer had higher maternal 25 (OH) D levels than those cART duration and maternal 25 (OH) D levels (p = 0.031, Spearman correlation =0.28).

Conclusions
Our findings show high mean levels of maternal 25 (OH) D in late pregnancy in our setting and in the absence of vitamin D supplementation. Both HIV infection and season are significant determinants of maternal vitamin D levels. Summer season is associated with higher maternal plasma 25 (OH) D levels. HIV infection is associated with increased maternal vitamin D levels. Prolonged use of cART, Tenolam E is associated with improved maternal 25(OH) D levels.