title: 25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings.
abstract: BACKGROUND
  Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking.
  
  
  METHODS
  A case-cohort study (N = 411) was nested within a randomized cART trial of 1571 cART-naive adults in 8 resource-limited settings and the United States. The primary outcome (WHO stage 3/4 disease or death within 96 weeks of cART initiation) was met by 192 cases, and 152 and 29 cases met secondary outcomes of virologic and immunologic failure. We studied prevalence and risk factors for baseline low 25(OH)D (<32 ng/mL) and examined associated outcomes using proportional hazard models.
  
  
  RESULTS
  Low 25(OH)D prevalence was 49% and ranged from 27% in Brazil to 78% in Thailand. Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09-4.18) and virologic failure (aHR 2.42; 95% CI, 1.33-4.41).
  
  
  CONCLUSIONS
  Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure. Studies examining the potential benefit of vitamin D supplementation among HIV patients initiating cART are warranted.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Havers
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University.
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland HIV Clinical Trials Unit, B.J. Medical College, Pune, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Detrick
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Bloomberg School of Public Health, Johns Hopkins University HIV Clinical Trials Unit, B.J. Medical College, Pune, India.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.affiliation: Department of Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.affiliation: YRGCARE Medical Centre, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Adriana
authors.initials: A
authors.lastname: Andrade
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: IMPACTA PERU Clinical Trials Unit, Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
authors.forename: Javier R
authors.initials: JR
authors.lastname: Lama
authors.affiliation: Division of Infectious Diseases, University of Colorado Denver, Aurora.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Bloomberg School of Public Health, Johns Hopkins University HIV Clinical Trials Unit, B.J. Medical College, Pune, India.
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019049:Developed Countries; D003906:Developing Countries; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D017211:Treatment Failure; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency
chemical_list: D044966:Anti-Retroviral Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: ART; Africa; Americas; Asia; HIV; Vitamin D; micronutrient; mortality