Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: A longitudinal study

Amara Esther Ezeamama, David Guwatudde, Molin Wang, Danstan Bagenda, Rachel Kyeyune, Christopher Sudfeld, Yukari C. Manabe, Wafaie W. Fawzi

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background & aims We implemented a prospective study among human immunodeficiency virus (HIV)-positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4+T-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4+T-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4+T-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4+T- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4+T-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/μl (99% CI: −77, 26) to a maximum deficit of 65 cells/μl (99% CI: −125, −5.5) during follow-up. This VDD-associated lower absolute CD4+T-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions VDD is associated with lower absolute CD4+T-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4+T-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.

Original languageEnglish (US)
Pages (from-to)1110-1117
Number of pages8
JournalClinical Nutrition
Volume35
Issue number5
DOIs
StatePublished - Oct 1 2016

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Vitamin D Deficiency
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Longitudinal Studies
HIV
T-Lymphocytes
Vitamin D
Micronutrients
Vitamins
Linear Models
Body Mass Index
Placebos
Prospective Studies
Confidence Intervals

Keywords

  • Antiretroviral therapy
  • CD4+
  • HIV
  • Immune recovery
  • T-cell count
  • Vitamin-D

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy : A longitudinal study. / Ezeamama, Amara Esther; Guwatudde, David; Wang, Molin; Bagenda, Danstan; Kyeyune, Rachel; Sudfeld, Christopher; Manabe, Yukari C.; Fawzi, Wafaie W.

In: Clinical Nutrition, Vol. 35, No. 5, 01.10.2016, p. 1110-1117.

Research output: Contribution to journalArticle

Ezeamama, AE, Guwatudde, D, Wang, M, Bagenda, D, Kyeyune, R, Sudfeld, C, Manabe, YC & Fawzi, WW 2016, 'Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: A longitudinal study', Clinical Nutrition, vol. 35, no. 5, pp. 1110-1117. https://doi.org/10.1016/j.clnu.2015.08.007
Ezeamama, Amara Esther ; Guwatudde, David ; Wang, Molin ; Bagenda, Danstan ; Kyeyune, Rachel ; Sudfeld, Christopher ; Manabe, Yukari C. ; Fawzi, Wafaie W. / Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy : A longitudinal study. In: Clinical Nutrition. 2016 ; Vol. 35, No. 5. pp. 1110-1117.
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abstract = "Background & aims We implemented a prospective study among human immunodeficiency virus (HIV)-positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4+T-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4+T-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4+T-cell count and associated 99{\%} confidence intervals at baseline and respective follow-up intervals. Results At baseline 23{\%}, 60{\%} and 17{\%} of participants were VDS, VDI and VDD, respectively. Absolute CD4+T- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4+T-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/μl (99{\%} CI: −77, 26) to a maximum deficit of 65 cells/μl (99{\%} CI: −125, −5.5) during follow-up. This VDD-associated lower absolute CD4+T-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions VDD is associated with lower absolute CD4+T-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4+T-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.",
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T1 - Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy

T2 - A longitudinal study

AU - Ezeamama, Amara Esther

AU - Guwatudde, David

AU - Wang, Molin

AU - Bagenda, Danstan

AU - Kyeyune, Rachel

AU - Sudfeld, Christopher

AU - Manabe, Yukari C.

AU - Fawzi, Wafaie W.

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N2 - Background & aims We implemented a prospective study among human immunodeficiency virus (HIV)-positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4+T-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4+T-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4+T-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4+T- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4+T-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/μl (99% CI: −77, 26) to a maximum deficit of 65 cells/μl (99% CI: −125, −5.5) during follow-up. This VDD-associated lower absolute CD4+T-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions VDD is associated with lower absolute CD4+T-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4+T-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.

AB - Background & aims We implemented a prospective study among human immunodeficiency virus (HIV)-positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4+T-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4+T-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4+T-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4+T- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4+T-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/μl (99% CI: −77, 26) to a maximum deficit of 65 cells/μl (99% CI: −125, −5.5) during follow-up. This VDD-associated lower absolute CD4+T-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions VDD is associated with lower absolute CD4+T-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4+T-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.

KW - Antiretroviral therapy

KW - CD4+

KW - HIV

KW - Immune recovery

KW - T-cell count

KW - Vitamin-D

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