title: Change in vitamin d levels occurs early after antiretroviral therapy initiation and depends on treatment regimen in resource-limited settings.
abstract: BACKGROUND
  Vitamin D has wide-ranging effects on the immune system, and studies suggest that low serum vitamin D levels are associated with worse clinical outcomes in HIV. Recent studies have identified an interaction between antiretrovirals used to treat HIV and reduced serum vitamin D levels, but these studies have been done in North American and European populations.
  
  
  METHODS
  Using a prospective cohort study design nested in a multinational clinical trial, we examined the effect of three combination antiretroviral (cART) regimens on serum vitamin D levels in 270 cART-naïve, HIV-infected adults in nine diverse countries, (Brazil, Haiti, Peru, Thailand, India, Malawi, South Africa, Zimbabwe and the United States). We evaluated the change between baseline serum vitamin D levels and vitamin D levels 24 and 48 weeks after cART initiation.
  
  
  RESULTS
  Serum vitamin D levels decreased significantly from baseline to 24 weeks among those randomized to efavirenz/lamivudine/zidovudine (mean change: -7.94 [95% Confidence Interval (CI) -10.42, -5.54] ng/ml) and efavirenz/emtricitabine/tenofovir-DF (mean change: -6.66 [95% CI -9.40, -3.92] ng/ml) when compared to those randomized to atazanavir/emtricitabine/didanosine-EC (mean change: -2.29 [95% CI -4.83, 0.25] ng/ml). Vitamin D levels did not change significantly between week 24 and 48. Other factors that significantly affected serum vitamin D change included country (p<0.001), season (p<0.001) and baseline vitamin D level (p<0.001).
  
  
  CONCLUSIONS
  Efavirenz-containing cART regimens adversely affected vitamin D levels in patients from economically, geographically and racially diverse resource-limited settings. This effect was most pronounced early after cART initiation. Research is needed to define the role of Vitamin D supplementation in HIV care.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Fiona P
authors.initials: FP
authors.lastname: Havers
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Barbara
authors.initials: B
authors.lastname: Detrick
authors.affiliation: Evandro Chagas Clinical Research Institute (IPEC), FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Cardoso
authors.affiliation: College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Sima
authors.initials: S
authors.lastname: Berendes
authors.affiliation: Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
authors.forename: Javier R
authors.initials: JR
authors.lastname: Lama
authors.affiliation: Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Patcharaphan
authors.initials: P
authors.lastname: Sugandhavesa
authors.affiliation: University of Witswatersrand, Johannesburg, South Africa.
authors.forename: Noluthando H
authors.initials: NH
authors.lastname: Mwelase
authors.affiliation: University of Colorado Denver, Aurora, Colorado, United States of America.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D001741:Black or African American; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006295:Health Resources; D006801:Humans; D008297:Male; D012044:Regression Analysis; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood*
chemical_list: D044966:Anti-Retroviral Agents; D014807:Vitamin D
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