Vitamin D status and immune function reconstitution in HIV-infected men initiating therapy

Alison Gump Abraham, Long Zhang, Keri Calkins, Adrienne Tin, Andrew Hoofnagle, Frank J. Palella, Michelle M. Estrella, Lisa Paula Jacobson, Mallory D. Witt, Lawrence A. Kingsley, Todd T Brown

Research output: Contribution to journalArticle

Abstract

Objective: Despite effective antiretroviral therapy (HAART) and durable viral suppression, many HIV-infected individuals still do not achieve CD4+cell count (CD4 +) normalization. Vitamin D has immunoregulatory functions, including inducing the development of T cells and higher levels may improve CD4+rebound. Design: Longitudinal study of men from the Multicenter AIDS Cohort Study who virally suppressed following HAART initiation and had pre-HAART and post-HAART 25(OH)D and 1,25(OH) 2 D measurements and repeated measures of CD4 +. Methods: CD4+rebound was modeled using a nonlinear mixed effects model. We estimated the adjusted effect (adjusted for pre-HAART antiretroviral exposure, black race, age and CD4+at HAART initiation) of pre-HAART and post-HAART vitamin D metabolite levels on the rate of CD4+increase and final CD4+plateau. Results: Among the 263 HIV-infected HAART initiators with pre-HAART vitamin D measurements, a 1-SD higher pre-HAART 25(OH) 2 D level was associated with a 9% faster rate of rise (P = 0.02) but no gain in final CD4+plateau. In contrast, a 1-SD higher 1,25(OH) 2 D level was associated with a 43-cell lower final CD4+(P = 0.04). Among 560 men with post-HAART measurements, findings were similar to those for pre-HAART 25(OH) 2 D with 1-SD higher level associated with faster rate of rise but no improvement in final CD4 +. Conclusion: We found no evidence that higher vitamin D metabolite levels pre-HAART or post-HAART are associated with better CD4+outcomes among HIV-infected HAART initiators. However, the value of pre-HAART 1,25(OH) 2 D levels as an indicator of immune response dysregulation could be further explored.

Original languageEnglish (US)
Pages (from-to)1069-1076
Number of pages8
JournalAIDS
Volume32
Issue number8
DOIs
StatePublished - May 15 2018

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Highly Active Antiretroviral Therapy
Vitamin D
HIV
Therapeutics
CD4 Lymphocyte Count

Keywords

  • HIV infection
  • immune reconstitution
  • Vitamin D

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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Vitamin D status and immune function reconstitution in HIV-infected men initiating therapy. / Abraham, Alison Gump; Zhang, Long; Calkins, Keri; Tin, Adrienne; Hoofnagle, Andrew; Palella, Frank J.; Estrella, Michelle M.; Jacobson, Lisa Paula; Witt, Mallory D.; Kingsley, Lawrence A.; Brown, Todd T.

In: AIDS, Vol. 32, No. 8, 15.05.2018, p. 1069-1076.

Research output: Contribution to journalArticle

Abraham, AG, Zhang, L, Calkins, K, Tin, A, Hoofnagle, A, Palella, FJ, Estrella, MM, Jacobson, LP, Witt, MD, Kingsley, LA & Brown, TT 2018, 'Vitamin D status and immune function reconstitution in HIV-infected men initiating therapy', AIDS, vol. 32, no. 8, pp. 1069-1076. https://doi.org/10.1097/QAD.0000000000001782
Abraham, Alison Gump ; Zhang, Long ; Calkins, Keri ; Tin, Adrienne ; Hoofnagle, Andrew ; Palella, Frank J. ; Estrella, Michelle M. ; Jacobson, Lisa Paula ; Witt, Mallory D. ; Kingsley, Lawrence A. ; Brown, Todd T. / Vitamin D status and immune function reconstitution in HIV-infected men initiating therapy. In: AIDS. 2018 ; Vol. 32, No. 8. pp. 1069-1076.
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AU - Abraham, Alison Gump

AU - Zhang, Long

AU - Calkins, Keri

AU - Tin, Adrienne

AU - Hoofnagle, Andrew

AU - Palella, Frank J.

AU - Estrella, Michelle M.

AU - Jacobson, Lisa Paula

AU - Witt, Mallory D.

AU - Kingsley, Lawrence A.

AU - Brown, Todd T

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N2 - Objective: Despite effective antiretroviral therapy (HAART) and durable viral suppression, many HIV-infected individuals still do not achieve CD4+cell count (CD4 +) normalization. Vitamin D has immunoregulatory functions, including inducing the development of T cells and higher levels may improve CD4+rebound. Design: Longitudinal study of men from the Multicenter AIDS Cohort Study who virally suppressed following HAART initiation and had pre-HAART and post-HAART 25(OH)D and 1,25(OH) 2 D measurements and repeated measures of CD4 +. Methods: CD4+rebound was modeled using a nonlinear mixed effects model. We estimated the adjusted effect (adjusted for pre-HAART antiretroviral exposure, black race, age and CD4+at HAART initiation) of pre-HAART and post-HAART vitamin D metabolite levels on the rate of CD4+increase and final CD4+plateau. Results: Among the 263 HIV-infected HAART initiators with pre-HAART vitamin D measurements, a 1-SD higher pre-HAART 25(OH) 2 D level was associated with a 9% faster rate of rise (P = 0.02) but no gain in final CD4+plateau. In contrast, a 1-SD higher 1,25(OH) 2 D level was associated with a 43-cell lower final CD4+(P = 0.04). Among 560 men with post-HAART measurements, findings were similar to those for pre-HAART 25(OH) 2 D with 1-SD higher level associated with faster rate of rise but no improvement in final CD4 +. Conclusion: We found no evidence that higher vitamin D metabolite levels pre-HAART or post-HAART are associated with better CD4+outcomes among HIV-infected HAART initiators. However, the value of pre-HAART 1,25(OH) 2 D levels as an indicator of immune response dysregulation could be further explored.

AB - Objective: Despite effective antiretroviral therapy (HAART) and durable viral suppression, many HIV-infected individuals still do not achieve CD4+cell count (CD4 +) normalization. Vitamin D has immunoregulatory functions, including inducing the development of T cells and higher levels may improve CD4+rebound. Design: Longitudinal study of men from the Multicenter AIDS Cohort Study who virally suppressed following HAART initiation and had pre-HAART and post-HAART 25(OH)D and 1,25(OH) 2 D measurements and repeated measures of CD4 +. Methods: CD4+rebound was modeled using a nonlinear mixed effects model. We estimated the adjusted effect (adjusted for pre-HAART antiretroviral exposure, black race, age and CD4+at HAART initiation) of pre-HAART and post-HAART vitamin D metabolite levels on the rate of CD4+increase and final CD4+plateau. Results: Among the 263 HIV-infected HAART initiators with pre-HAART vitamin D measurements, a 1-SD higher pre-HAART 25(OH) 2 D level was associated with a 9% faster rate of rise (P = 0.02) but no gain in final CD4+plateau. In contrast, a 1-SD higher 1,25(OH) 2 D level was associated with a 43-cell lower final CD4+(P = 0.04). Among 560 men with post-HAART measurements, findings were similar to those for pre-HAART 25(OH) 2 D with 1-SD higher level associated with faster rate of rise but no improvement in final CD4 +. Conclusion: We found no evidence that higher vitamin D metabolite levels pre-HAART or post-HAART are associated with better CD4+outcomes among HIV-infected HAART initiators. However, the value of pre-HAART 1,25(OH) 2 D levels as an indicator of immune response dysregulation could be further explored.

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