The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Vitamin D Deficiency in HIV-Infected Children

Authors: Ayesha Mirza, MD, Saran Wells, MD, Tabitha Gayton, RN, PhD, Carmen Smotherman, MS, Azeem Rathore , Dale Kraemer, PhD, Mobeen Rathore, MD

Abstract

Objectives: Improvement in life expectancy with the use of combination antiretroviral therapy has come with the recognition of the complications associated with chronic human immunodeficiency virus infection. Vitamin D has been of particular interest because of its effect on bone health and immune functions. The purpose of this study was to assess vitamin D status in children in relation to the duration and severity of their human immunodeficiency virus infection and nutritional status, as well as to determine whether there was any effect of seasonality.

Methods: The study design was cross-sectional and all children 0 to 21 years of age were eligible to participate.

Results: A total of 59 participants provided informed consent, with 54 subjects completing all study activities. Thirteen (24.1%) had sufficient vitamin D levels, 13 (24.1%) had insufficient levels, and 28 (51.9%) had deficient levels per the guidelines of the Endocrine Society. In our univariate analysis, younger age was associated with higher vitamin D levels ( P = 0.030). Higher CD4 counts were associated with higher vitamin D levels ( P = 0.018). A significant association between the vitamin D intake per day and vitamin D level was seen ( P = 0.013). In the multivariate analysis, the best ordinal logistic regression model had the CD4 count as predictor ( P < 0.005), higher CD4 counts were associated with decreased odds of vitamin D deficiency (odds ratio 0.47, 95% confidence interval 0.28–0.80).

Conclusions: Vitamin D deficiency was common among the patients included in this study.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med 2008;359:2233-2244.
 
2. Judd A, Doerholt K, Tookey PA, et al. Morbidity, mortality, and response to treatment by children in the United Kingdom and Ireland with perinatally acquired HIV infection during 1996-2006: planning for teenage and adult care. Clin Infect Dis 2007;45:918-924.
 
3. Viani RM, Araneta MR, Deville JG, et al. Decrease in hospitalization and mortality rates among children with perinatally acquired HIV type 1 infection receiving highly active antiretroviral therapy. Clin Infect Dis 2004;39:725-731.
 
4. Barlow-Mosha L, Eckard AR, McComsey GA, et al. Metabolic complications and treatment of perinatally HIV-infected children and adolescents. J Int AIDS Soc 2013;16:18600.
 
5. Leonard EG, McComsey GA. Antiretroviral therapy in HIV-infected children: the metabolic cost of improved survival. Infect Dis Clin North Am 2005;19:713-729.
 
6. Bailey DA, Martin AD, McKay HA, et al. Calcium accretion in girls and boys during puberty: a longitudinal analysis. J Bone Miner Res 2000;15:2245-2250.
 
7. Misra M, Pacaud D, Petryk A, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417.
 
8. Barber Y, Rubio C, Ferná E, et al. Host genetic background at CCR5 chemokine receptor and vitamin D receptor loci and human immunodeficiency virus (HIV) type 1 disease progression among HIV-seropositive injection drug users. J Infect Dis 2001;184:1279-1288.
 
9. Mehta S, Giovannucci E, Mugusi FM, et al. Vitamin D status of HIV-infected women and its association with HIV disease progression, anemia, and mortality. PLoS One 2010;5:e8770.
 
10. Mehta S, Hunter DJ, Mugusi FM, et al. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis 2009;200:1022-1030.
 
11. Havers F, Smeaton L, Gupte N, et al. 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;210:244-253.
 
12. Espert L, Biard-Piechaczyk M. Autophagy in HIV-induced T cell death. Curr Top Microbiol Immunol 2009;335:307-321.
 
13. Espert L, Denizot M, Grimaldi M, et al. Autophagy and CD4+ T lymphocyte destruction by HIV-1. Autophagy 2007;3:32-34.
 
14. Zhou D, Spector SA. Human immunodeficiency virus type-1 infection inhibits autophagy. AIDS 2008;22:695-699.
 
15. Shepherd L, Souberbielle JC, Bastard JP, et al. Prognostic value of vitamin D level for all-cause mortality, and association with inflammatory markers, in HIV-infected persons. J Infect Dis 2014;210:234-243.
 
16. Meyzer C, Frange P, Chappuy H, et al. Vitamin D deficiency and insufficiency in HIV-infected children and young adults. Pediatr Infect Dis J 2013;32:1240-1244.
 
17. Chokephaibulkit K, Saksawad R, Bunupuradah T, et al. Prevalence of vitamin D deficiency among perinatally HIV-infected Thai adolescents receiving antiretroviral therapy. Pediatr Infect Dis J 2013;32:1237-1239.
 
18. Rutstein R, Downes A, Zemel B, et al. Vitamin D status in children and young adults with perinatally acquired HIV infection. Clin Nutr 2011;30:624-628.
 
19. Poowuttikul P, Thomas R, Hart B, et al. Vitamin D insufficiency/deficiency in HIV-infected inner city youth. J Int Assoc Provid AIDS Care 2014;13:438-442.
 
20. Kumar J, Muntner P, Kaskel FJ, et al. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009;124:e362-e370.
 
21. Blalock SJ, Norton LL, Patel RA, et al. Development and assessment of a short instrument for assessing dietary intakes of calcium and vitamin D. J Am Pharm Assoc (2003) 2003;43:685-693.
 
22. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-1930.
 
23. Heald AH, Anderson SG, Scargill JJ, et al. Measuring vitamin D levels: surrogates are insufficient. Int J Clin Pract 2015;69:131-135.
 
24. Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2002;76:187-192.
 
25. Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr 2008;88:558S-564S.
 
26. Looker AC, Pfeiffer CM, Lacher DA, et al. Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004. Am J Clin Nutr 2008;88:1519-1527.
 
27. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res 2011;31:48-54.
 
28. O'Connor MY, Thoreson CK, Ramsey NL, et al. The uncertain significance of low vitamin D levels in African descent populations: a review of the bone and cardiometabolic literature. Prog Cardiovasc Dis 2013;56:261-269.