title: Is vitamin D deficiency involved in the immune reconstitution inflammatory syndrome?
abstract: BACKGROUND
  About 20-30% of persons with HIV infection, especially those living in countries with limited resources, experience an immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral treatment. The active form of vitamin D, 1,25-dihydroxyvitamin D, is a key player in the clearance of pathogens and influences the level of inflammation and macrophage activation.
  
  
  OBJECTIVE
  We hypothesize that low availability of 1,25-dihydroxyvitamin D, either due to vitamin D deficiency or due to polymorphisms in the vitamin D receptor or in its activating/inactivating enzymes, contributes to the appearance of IRIS. Furthermore, drug interactions with the enzymatic pathways of vitamin D could favour the development of IRIS.
  
  
  METHODS
  Our hypothesis could be explored by a case-control study to assess the prevalence of vitamin D deficiency in HIV-infected patients on antiretroviral treatment who develop and do not develop IRIS.
  
  
  CONCLUSIONS
  If the role of vitamin D in IRIS is confirmed, we would be able to screen patients at risk for IRIS by screening for vitamin D deficiency. After confirmation by means of a clinical trial, vitamin D supplementation could be a cheap and safe way to reduce the incidence of IRIS.
authors.affiliation: Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium. aconesa@itg.be
authors.forename: Anali
authors.initials: A
authors.lastname: Conesa-Botella
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Moreno-Reyes
authors.forename: Evelyne
authors.initials: E
authors.lastname: van Etten
authors.forename: Lut
authors.initials: L
authors.lastname: Lynen
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens