title: Vitamin D and clinical disease progression in HIV infection: results from the EuroSIDA study.
abstract: BACKGROUND
  We examined the association between vitamin D [25(OH)D] level and disease progression in HIV infection.
  
  
  METHODS
  Within the EuroSIDA study, 2000 persons were randomly selected for 25(OH)D measurement in stored plasma samples closest to study entry. 25(OH)D results were stratified into tertiles. Factors associated with 25(OH)D levels and associations of 25(OH) levels with subsequent risk of all-cause mortality, AIDS and non-AIDS events were analyzed.
  
  
  RESULTS
  Of 1985 persons with 25(OH)D levels available, 23.7% had 25(OH)D below 10, 65.3% between 10 and 30, and 11% above 30 ng/ml. At the time of 25(OH)D measurement, older persons, persons of black ethnic origin, living outside Southern Europe/Argentina, sampled during winter, and infected with HIV through nonhomosexual exposure were at higher odds of having low 25(OH)D levels, whereas persons receiving protease inhibitors were at lower odds. Compared to those in the lowest 25(OH)D tertile (<12 ng/ml), those in the middle (12-20) and higher (>20) tertiles had a significantly lower risk of clinical progression during subsequent follow-up. Adjusted incidence rate ratios for all-cause mortality were 0.68 (95% CI 0.47-0.99, P = 0.045) and 0.56 (95% CI 0.37-0.83, P = 0.0039), and for AIDS events were 0.58 (95% CI 0.39-0.87, P = 0.0086) and 0.61 (95% CI 0.40-0.93, P = 0.020), for the middle and higher tertiles, respectively. There was a similar, nonsignificant reduced incidence of non-AIDS events in the middle and higher tertiles.
  
  
  CONCLUSIONS
  25(OH)D deficiency was frequent in HIV-infected persons (83% on combined antiretroviral therapy), and was independently associated with a higher risk of mortality and AIDS events. Causality relationships should be examined, because of potential public health consequences.
authors.affiliation: Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, APHP, Paris, France. jean-paul.viard@htd.aphp.fr
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viard
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Joanne
authors.initials: J
authors.lastname: Reekie
authors.forename: Brygida
authors.initials: B
authors.lastname: Knysz
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.forename: Jose
authors.initials: J
authors.lastname: Gatell
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Bogner
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood*; D000328:Adult; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000401:mortality
chemical_list: D014807:Vitamin D