593
Vitamin Deficiency in Children with Perinatally Acquired HIV Infection
Richard Rutstein*1, A Downes2, B Zemel1, J Schall1, B Hollis3, and V Stallings1
1Children`s Hosp of Philadelphia, PA, US; 2Univ of Pennsylvania Sch of Med, Philadelphia, US; and 3Med Univ of South Carolina, Charleston, US
Background: Vitamin D is important for calcium
absorption and bone growth, and it may contribute to the prevention of
hypertension, diabetes, and cancer. Vitamin D also promotes innate immunity and
may play an important role in combating infections, such as tuberculosis.
Vitamin D insufficiency is common among otherwise healthy children and
adolescents, and HIV+ individuals are at increased risk for
osteopenia and osteoporosis. We assessed vitamin D status (based on 25-hydroxy
vitamin D concentrations) in children with perinatally acquired HIV infection
and compared to a geographically similar reference group of healthy children.
Methods: Banked blood samples from 87 HIV+
children and adolescents, followed at 1 urban center, were analyzed for
25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, and parathyroid hormone
concentrations. Results were compared to healthy controls. Vitamin D deficiency
was defined as 25-hydroxy vitamin D <11 ng/mL; vitamin D insufficiency as
25-hydroxy vitamin D <30 ng/mL; normal parathyroid hormone concentrations as
9 to 52 ρg/mL. Results between groups were compared using multivariable
techniques to adjust for the known risk factors in healthy children.
Results:
|
|
HIV+
|
Control group
|
|
n
|
87
|
332
|
|
Mean Age
|
13.3+4.7
|
12.3+3.4
|
|
% Black
|
77%
|
38%
|
|
% Female
|
48%
|
52%
|
|
Body mass index
|
21.2
|
19.7
|
|
Mean 25-hydroxyVitamin D (ng/mL)
Vitamin D Insufficiency
Vitamin D Deficiency
|
17.2±11.7
89%
34%
|
21.4±9.9 (p<0.001)
55%
7%
|
|
Elevated parathyroid hormone
|
2%
|
8%
|
For the control group, the correlation between parathyroid
hormone and 25-hydroxyVitamin D was r = –0.31, p <0.001. There
was no significant association between parathyroid hormone and
25-hydroxyVitamin D concentrations in the HIV+ group.
|
Multivariate Analysis
|
Vitamin D deficiency
(25-hydroxy vitamin D <11 ng/mL)
|
|
|
Odds Ratio 95%CI
|
|
Age, yr
|
1.21 1.08 to 1.35
|
|
Body mass index z-score
|
1.85 1.25 to 2.75
|
|
Season (vs summer)
Winter
|
19.40 5.81 to 64.70
|
|
Black race
|
10.62 4.06 to 27.78
|
|
HIV status
|
5.59 2.53 to 12.37
|
The adjusted odds ratio for Vitamin D insufficiency with HIV+
was 3.80 (1.84 to 6.72).
Conclusions: Likelihood of vitamin D deficiency and
insufficiency is a significantly increased in children with perinatally
acquired HIV compared to a healthy reference group of similar age, race,
region, and season. The relationship between parathyroid hormone and 25-hydroxy
vitamin D concentrations may be altered in this at-risk group. compared to
controls. Further research is needed to determine the health benefits of
vitamin D supplementation in HIV-infected youth.
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