Studies on Vitamin D Levels in Serum of HIV Infected Patients: Their Effect on Progression towards AIDS

Catherine Wanjiru Gichuhi^1*, Daniel Kariuki¹, Andrew Nyerere², Malkit Riyat³

¹Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
²Department of Medical Microbiology, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
³Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya.

DOI: 10.4236/wja.2014.44050                

Abstract

Vitamin D deficiency may be more prevalent among HIV-positive patients than in the general population due to HIV disease-related factors. This study examined the effects of HIV infection and use of antiretroviral drugs in serum vitamin D levels in HIV patients visiting Aga Khan University Hospital, Nairobi Kenya from October 2013 to April 2014. The effect of vitamin D status on CD₄ cell count and HIV viral load was evaluated to determine the status of disease progression to AIDS. HIV viral load in blood samples was determined using COBAS Ampliprep/TaqMan HIV-1 test kit while CD₄ cell counts were done using the fluorescence-activated cell sorter system. The levels of vitamin D in serum were determined using electrochemiluminescence binding assay in Cobas E601 mass analyzers. In addition, selected plasma enzymes were used to evaluate liver function. Higher percentage (49.12%) of deficient vitamin D cases were observed among HIV patients not on ART. Deficient levels of Vitamin D were associated with abnormal selected liver enzymes. High viral load was observed among patients not on ART with deficient and insufficient vitamin D. The CD₄ cell count was higher in patients on ART with sufficient vitamin D levels compared to those with deficient vitamin D. These observations suggest a need to supplement ART with vitamin D in order to ameliorate Vitamin D deficiency as a strategy to improve HIV management.

Keywords

Vitamin D, HIV Patients, ART, Viral Load, CD4 Count

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mehta, S., Giovannucci, E., Mugusi, M., Spiegelman, D., Aboud, S., Hertzmark, E., et al. (2010) Vitamin D Status of HIV-Infected Women and Its Association with HIV Disease Progression, Anemia, and Mortality. PLOS ONE, 5, e8770. http://dx.doi.org/10.1371/journal.pone.0008770
[2]	Holick, M.F. (2007) Vitamin D Deficiency. New England Journal of Medicine, 357, 266-281. http://dx.doi.org/10.1056/NEJMra070553
[3]	Haug, C., Muller, F., Aukrust, P. and Froland, S.S. (1994) Subnormal Serum Concentration of 1, 25-Vitamin D in Human Immunodeficiency Virus Infection: Correlation with Degree of Immune Deficiency and Survival. Journal of Infectious Diseases, 169, 889-893. http://dx.doi.org/10.1093/infdis/169.4.889
[4]	Fawzi, W.W., Msamanga, G.I., Spiegelman, D., Wei, R. and Kapiga, S. (2004) A Randomized Trial of Multivitamin Supplements and HIV Disease Progression and Mortality. New England Journal of Medicine, 351, 23-32. http://dx.doi.org/10.1056/NEJMoa040541
[5]	Melamed, M.L., Michos, E.D., Post, W. and Astor, B. (2008) 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population. Archives of Internal Medicine, 168, 1629-1637. http://dx.doi.org/10.1001/archinte.168.15.1629
[6]	Van Den Bout Van Den Beukel, C.J., Fievez, L., Michels, M., Sweep, F.C., Hermus, A.R., Bosch, M.E., et al. (2008) Vitamin D Deficiency among HIV Type 1-Infected Individuals in the Netherlands: Effects of Antiretroviral Therapy. AIDS Research and Human Retroviruses, 24, 1375-1382. http://dx.doi.org/10.1089/aid.2008.0058
[7]	Yin, M. and Stein, E. (2011) The Effect of Antiretrovirals on Vitamin D. Clinical Infectious Diseases, 52, 406-408. http://dx.doi.org/10.1093/cid/ciq169
[8]	Childs, K., Welz, T., Samarawickrama, A. and Post, F.A. (2012) Effects of Vitamin D Deficiency and Combination Antiretroviral Therapy on Bone in HIV-Positive Patients. AIDS, 26, 253-262. http://dx.doi.org/10.1097/QAD.0b013e32834f324b
[9]	Allavena, C., Delpierre, C., Cuzin, L., Rey, D., Viget, N., et al. (2012) High Frequency of Vitamin D Deficiency in HIV-Infected Patients: Effects of HIV-Related Factors and Antiretroviral Drugs. Journal of Antimicrobial Chemotherapy, 67, 2222-2230. http://dx.doi.org/10.1093/jac/dks176
[10]	Fox, J., Peters, B., Prakash, M., Arribas, J., Hill, A., et al. (2011) Improvement in Vitamin D Deficiency Following Antiretroviral Regime Change: Results from the MONET Trial. AIDS Research and Human Retroviruses, 27, 29-34. http://dx.doi.org/10.1089/aid.2010.0081
[11]	Cheng, J.B., Levine, M.A., Bell, N.H., Mangelsdorf, D.J. and Russell, D.W. (2004) Genetic Evidence That the Human CYP2R1 Enzyme Is a Key Vitamin D 25-Hydroxylase. Proceedings of the National Academy of Sciences of the USA, 101, 7711-7715. http://dx.doi.org/10.1073/pnas.0402490101
[12]	Zhou, C., Assem, M., Tay, J.C., Watkins, P.B., Blumberg, B., et al. (2006) Steroid and Xenobiotic Receptor and Vitamin D Receptor Crosstalk Mediates CYP24 Expression and Drug-Induced Osteomalacia. Journal of Clinical Investigation, 116, 1703-1712. http://dx.doi.org/10.1172/JCI27793
[13]	Woodward, C., Hall, A., William, I., et al. (2009) Tenofovir-Associated Renal and Bone Toxicity. HIV Medication, 10, 482-487. http://dx.doi.org/10.1111/j.1468-1293.2009.00716.x
[14]	Peyriere, H., Reynes, J., Rouanet, I., et al. (2004) Renal Tubular Dysfunction Associated with Tenofovir Therapy. Journal of Acquired Immune Deficiency Syndromes, 35, 269-273. http://dx.doi.org/10.1097/00126334-200403010-00007
[15]	Allison, C.R., Suzanne, J., Meena, K., Corrynn, H., Norma, S., Daniella, L.T. and Grace, A.M. (2011) Vitamin D Linked to Carotid Intima-Media Thickness and Immune Reconstitution in HIV-Positive Individuals. Antiviral Therapy, 16, 555-563. http://dx.doi.org/10.3851/IMP1784
[16]	de Luis, D.A., Bachiller, P., Aller, R., et al. (2002) Relation among Micronutrient Intakes with CD4 Count in HIV Infected Patients. Nutricion Hospitalaria, 17, 285-289.
[17]	Kim, J.H., Gandhi, V., Psevdos Jr., G., Espinoza, F., Park, J. and Sharp, V. (2011) Evaluation of Vitamin D Levels among HIV-Infected Patients in New York City. AIDS Research and Human Retroviruses, 28, 235-241. http://dx.doi.org/10.1089/aid.2011.0040
[18]	Zanetti, M. (2004) Cathelicidins, Multifunctional Peptides of the Innate Immunity. Journal of Leukocyte Biology, 75, 39-48. http://dx.doi.org/10.1189/jlb.0403147
[19]	Zhang, Y., Shi, W., Tang, S., Li, J., Yin, S., Gao, X., Wang, L., Zou, L., Zhao, J., Huang, Y., Shan, L., Gounni, A.S., Wu, Y., Yuan, F. and Zhang, J. (2013) The Influence of Cathelicidin LL37 in Human Anti-Neutrophils Cytoplasmic Antibody (ANCA)-Associated Vasculitis. Arthritis Research Therapy, 15, R161. http://dx.doi.org/10.1186/ar4344
[20]	Heilborn, J.D., Nilsson, M.F., Chamorro Jimenez, C.I., Sandstedt, B., Borregaard, N., Tham, E., S?rensen, O.E., Weber, G. and St?hle, M. (2005) Antimicrobial Protein hCAP18/ LL-37 Is Highly Expressed in Breast Cancer and Is a Putative Growth Factor for Epithelial Cells. International Journal of Cancer, 114, 713-719. http://dx.doi.org/10.1002/ijc.20795
[21]	Wang, G., Watson, K.M. and Buckheit Jr., R.W. (2008) Anti-Human Immunodeficiency Virus Type 1 Activities of Antimicrobial Peptides Derived from Human and Bovine Cathelicidins. Antimicrobial Agents and Chemotherapy, 52, 3438-3440. http://dx.doi.org/10.1128/AAC.00452-08
[22]	Bergman, N., Moraes, K., Anderson, J., Zaric, B., Kambach, C., Schneider, R., et al. (2007) Lsm Proteins Bind and Stabilize RNAs Containing 5’ Poly(A) Tracts. Nature Structural Molecular Biology, 14, 824-831. http://dx.doi.org/10.1038/nsmb1287
[23]	Ginde, A.A., Mansbach, J.M. and Camargo Jr., C.A. (2009) Association between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine, 169, 384-390. http://dx.doi.org/10.1001/archinternmed.2008.560
[24]	Laaksi, I., Ruohola, J.P., Tuohimaa, P., Auvinen, A., Haataja, R., Pihlajam?ki, H. and Ylikomi, T. (2007) An Association of Serum Vitamin D Concentrations < 40 nmol/L with Acute Respiratory Tract Infection in Young Finnish Men. The American Journal of Clinical Nutrition, 86, 714-717.
[25]	Schwartz, J.B., Moore, K.L., Yin, M., Sharma, A., Merenstein, D., Islam, T., Golub, E.T., Tien, P.C. and Adeyemi, O.M. (2014) Study of HIV-Infected and Uninfected Women in the United States Relationship of Vitamin D, HIV, HIV Treatment, and Lipid Levels in the Women’s Interagency HIV. JIAPAC, 13, 250.
[26]	Rook, G.A., Steele, J., Fraher, L., Barler, S., Karmali, R., O’Riordan, J. and Stanford, J. (1986) Vitamin D3, Gamma Interferon, and Control of Proliferation of Mycobacterium tuberculosis by Human Monocytes. Immunology, 57, 159-163.
[27]	Mata, M.J., Gaytán, M.J., Grados-Chavarría, B.H., Fuentes-Allen, J.L., Arroyo-Anduiza, C.I. and Alfaro-Mejía, A. (2009) Correlation between HIV Viral load and Aminotransferases as Liver Damage Markers in HIV Infected Naive Patients: A Concordance Cross-Sectional Study. Virology Journal, 6, 181. http://dx.doi.org/10.1186/1743-422X-6-181
[28]	Dalla, P.M., Amorosa, V.K., Localio, R., Kostman, J.R. and Lo Re, V. (2010) Prevalence and Risk Factors for Significant Liver Fibrosis among HIV-Monoinfected Patients. BMC Infectious Diseases, 10, 116. http://dx.doi.org/10.1186/1471-2334-10-116
[29]	Crum, C.N., Grandits, G., Echols, S., Ganesan, A., Landrum, M., Weintrob, A., Barthel, R. and Agan, B. (2010) Trends and Causes of Hospitalizations among HIV-Infected Persons during the Late HAART Era: What Is the Impact of CD4 Counts and HAART Use? Journal of Acquired Immune Deficiency Syndromes, 54, 248-257. http://dx.doi.org/10.1097/QAI.0b013e3181c8ef22