Prognostic value of vitamin D level for all-cause mortality, and association with inflammatory markers, in HIV-infected persons.
BACKGROUND
Low 25-hydroxyvitamin D (25(OH)D) has been associated with inflammation, human immunodeficiency virus (HIV) disease progression, and death. We aimed to identify the prognostic value of 25(OH)D for AIDS, non-AIDS-defining events and death, and its association with immunological/inflammatory markers.


METHODS
Prospective 1-1 case-control study nested within the EuroSIDA cohort. Matched cases and controls for AIDS (n = 50 matched pairs), non-AIDS-defining (n = 63) events and death (n = 41), with plasma samples during follow-up were selected. Conditional logistic regression models investigated associations between 25(OH)D levels and annual 25(OH)D change and the probability of events. Mixed models investigated relationships between 25(OH)D levels and immunological/inflammatory markers.


RESULTS
In sum, 250 patients were included. Median time between first and last sample and last sample and event was 44.6(interquartile range [IQR]: 22.7-72.3) and 3.1(IQR: 1.4-6.4) months. Odds of death decreased by 46.0%(95% confidence interval [CI], 2.0-70.0, P = .04) for a 2-fold increase in latest 25(OH)D level. There was no association between 25(OH)D and the occurrence of AIDS or non-AIDS-defining events (P > .05). In patients with current 25(OH)D <10 ng/mL, hsIL-6 concentration increased by 4.7%(95% CI, .2,9.4, P = .04) annually after adjustment for immunological/inflammatory markers, and no change in hsCRP rate was observed (P = .76).


CONCLUSIONS
Low Vitamin D predicts short term mortality in HIV-positive persons. Effectiveness of vitamin D supplementation on inflammation and patient outcomes should be investigated.
Department of Infection and Population Health, University College London Medical School, London, United Kingdom.
Leah
L
Shepherd
Service d'Explorations Fonctionnelles, Hôpital Necker, Paris, France.
Jean-Claude
JC
Souberbielle
Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France.
Jean-Philippe
JP
Bastard
Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France.
Soraya
S
Fellahi
Department of Biochemistry, Hôpital Tenon, APHP, Paris, France INSERM, U938, Faculté de Médecine Saint Antoine, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France UPMC Univ Paris 06, UMR_S 938, Paris, France.
Jaqueline
J
Capeau
Department of Infection and Population Health, University College London Medical School, London, United Kingdom The Kirby Institute University of New South Wales, Sydney, New South Wales, Australia.
Joanne
J
Reekie
Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands.
Peter
P
Reiss
Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.
Anders
A
Blaxhult
HIVCENTER Haus 68, Frankfurt, Germany.
Markus
M
Bickel
Edinburgh Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom Edinburgh Infectious Diseases Edinburgh University, Edinburgh, United Kingdom.
Clifford
C
Leen
Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Centre for Viral Diseases, Rigshospitalet, Copenhagen, Denmark.
Ole
O
Kirk
Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Centre for Viral Diseases, Rigshospitalet, Copenhagen, Denmark.
Jens D
JD
Lundgren
Department of Infection and Population Health, University College London Medical School, London, United Kingdom.
Amanda
A
Mocroft
Centre de Diagnostic et de Thérapeutique Hôtel-Dieu, APHP, and EA 3620, Université Paris Descartes, Paris, France.
Jean-Paul
JP
Viard
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014807:Vitamin D / Q000097:blood*
D015415:Biomarkers; D014807:Vitamin D
C-reactive protein; HIV; IL-6; all-cause death; inflammation; soluble CD14; vitamin D