Is vitamin D deficiency involved in the immune reconstitution inflammatory syndrome?
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.
Conesa-Botella
Anali
A
Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium. aconesa@itg.be
Mathieu
Chantal
C
Colebunders
Robert
R
Moreno-Reyes
Rodrigo
R
van Etten
Evelyne
E
Lynen
Lut
L
Kestens
Luc
L