title: Vitamin D status of HIV-infected women and its association with HIV disease progression, anemia, and mortality.
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.
  
  
  RESULTS
  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
  Low vitamin D status (serum 25-hydroxyvitamin D<32 ng/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 follow-up. 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.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America. smehta@hsph.harvard.edu
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Mugusi
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: David
authors.initials: D
authors.lastname: Hunter
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D013636:Tanzania / Q000453:epidemiology; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D