Vitamin D and clinical disease progression in HIV infection: results from the EuroSIDA study

Background: We examined the association between vitamin D [ 25(OH) D] level and disease progression in HIV infection. Methods: Within the EuroSIDA study, 2000 persons were randomly selected for 25(OH) D measurement in stored plasma samples closest to study entry. 25(OH) D results were stratified into tertiles. Factors associated with 25(OH) D levels and associations of 25(OH) levels with subsequent risk of all-cause mortality, AIDS and non-AIDS events were analyzed. Results: Of 1985 persons with 25(OH) D levels available, 23.7% had 25(OH) D below 10, 65.3% between 10 and 30, and 11% above 30 ng/ml. At the time of 25(OH) D measurement, older persons, persons of black ethnic origin, living outside Southern Europe/Argentina, sampled during winter, and infected with HIV through nonhomo-sexual exposure were at higher odds of having low 25(OH) D levels, whereas persons receiving protease inhibitors were at lower odds. Compared to those in the lowest 25(OH) D tertile (<12 ng/ml), those in the middle (12-20) and higher (>20) tertiles had a significantly lower risk of clinical progression during subsequent follow-up. Adjusted incidence rate ratios for all-cause mortality were 0.68 (95% CI 0.47-0.99, P = 0.045) and 0.56 (95% CI 0.37-0.83, P = 0.0039), and for AIDS events were 0.58 (95% CI 0.39-0.87, P = 0.0086) and 0.61 (95% CI 0.40-0.93, P = 0.020), for the middle and higher tertiles, respectively. There was a similar, nonsignificant reduced incidence of non-AIDS events in the middle and higher tertiles. Conclusion: 25(OH) D deficiency was frequent in HIV-infected persons (83% on combined antiretroviral therapy), and was independently associated with a higher risk of mortality and AIDS events. Causality relationships should be examined, because of potential public health consequences. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins