title: Vitamin D status and its association with morbidity including wasting and opportunistic illnesses in HIV-infected women in Tanzania.
abstract: Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease. However, this association has not been examined in large studies or in resource-limited settings. Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation (excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-hydroxyvitamin D<32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m(2) during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]: 1.43; 95% confidence intervals: [1.03-1.99]). The relationship between continuous vitamin D levels and risk of BMI less than 18 kg/m(2) during follow-up was inverse and linear (p=0.03). Women with low vitamin D levels had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04-1.54]) and thrush (HR: 2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients, particularly in resource-limited settings.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA. smehta@cornell.edu
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Mugusi
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Julia L
authors.initials: JL
authors.lastname: Finkelstein
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D002180:Candidiasis, Oral / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D019587:Dietary Supplements; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D019247:HIV Wasting Syndrome / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood*; D014815:Vitamins / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014815:Vitamins; D014807:Vitamin D