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

8 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 25kg/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)
JournalClinical Nutrition
DOIs
StateAccepted/In press - Mar 23 2015
Externally publishedYes

Fingerprint

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

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

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, 23.03.2015.

Research output: Contribution to journalArticle

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. 2015.
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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 25kg/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.

PY - 2015/3/23

Y1 - 2015/3/23

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 25kg/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 25kg/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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