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CHANGE IN VITAMIN D LEVELS OCCURS EARLY AFTER ANTIRETROVIRAL THERAPY INITIATION AND DEPENDS ON TREATMENT REGIMEN IN RESOURCE-LIMITED SETTINGS
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Affilliation
Johns Hopkins University School of Medicine. Baltimore, MD, USA / Johns Hopkins University Bloomberg School of Public Health. Baltimore, MD, USA.
Johns Hopkins University School of Medicine. Baltimore, MD, USA.
Fundação Oswaldo cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
College of Medicine-Johns Hopkins University Research Project. Blantyre, Malawi / Liverpool School of Tropical Medicine. Liverpool, United Kingdom.
Asociacion Civil Impacta Salud y Educacion. Lima, Peru.
Chiang Mai University. Chiang Mai, Thailand.
University of Witswatersrand. Johannesburg, South Africa.
University of Colorado Denver. Aurora, CO, USA.
Johns Hopkins University School of Medicine. Baltimore, MD, USA / Johns Hopkins University Bloomberg School of Public Health. Baltimore, MD, USA.
Johns Hopkins University School of Medicine. Baltimore, MD, USA.
Fundação Oswaldo cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
College of Medicine-Johns Hopkins University Research Project. Blantyre, Malawi / Liverpool School of Tropical Medicine. Liverpool, United Kingdom.
Asociacion Civil Impacta Salud y Educacion. Lima, Peru.
Chiang Mai University. Chiang Mai, Thailand.
University of Witswatersrand. Johannesburg, South Africa.
University of Colorado Denver. Aurora, CO, USA.
Johns Hopkins University School of Medicine. Baltimore, MD, USA / Johns Hopkins University Bloomberg School of Public Health. Baltimore, MD, USA.
Abstract
Study 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-naı¨ve, 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: 27.94 [95% Confidence Interval (CI) 210.42, 25.54] ng/ml) and efavirenz/ emtricitabine/tenofovir-DF (mean change: 26.66 [95% CI 29.40, 23.92] ng/ml) when compared to those randomized to atazanavir/emtricitabine/didanosine-EC (mean change: 22.29 [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). Conclusion: 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.
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