Abstract:
Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in
immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease.
However, this association has not been examined in large studies or in resource-limited settings. Vitamin D
levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation
(excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during
follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to
assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-
hydroxyvitamin D< 32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m2
during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]:
1.43; 95% confidence intervals: [1.03–1.99]). The relationship between continuous vitamin D levels and risk of
BMI less than 18 kg/m2 during follow-up was inverse and linear ( p = 0.03). Women with low vitamin D levels
had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04–1.54]) and thrush (HR:
2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk
factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in
Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could
represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients,
particularly in resource-limited settings.
