Abstract:
Background: Vitamin D has a potential role in slowing HIV disease progression and preventing mortality based on its
extensive involvement in the immune system; however, this relationship has not been examined in large studies or in
resource-limited settings.
Methodology/Principal Findings: Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a
trial of multivitamin supplementation (not including vitamin D) in Tanzania. Women were followed up for a median of 69.5
months, and information on hemoglobin levels, HIV disease progression, and mortality was recorded. Proportional hazard
models and generalized estimating equations were used to assess the relationship of these outcomes with vitamin D status.
Conclusions/Significance: 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 followup.
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.
