Vitamin D supplementation and endothelial function in vitamin D deficient HIV-infected patients: a randomized placebo-controlled trial

• Type of Material: Article
• Authors: Chris T Longenecker, University Hospitals Case Medical Center; Corrilynn O Hileman, Case Western Reserve University; Teresa L Carman, University Hospitals Case Medical Center; Allison C Ross, Emory University; Shabnam Seydafkan, Emory University; Todd T Brown, Johns Hopkins University; Danielle E Labbato, University Hospitals Case Medical Center; Norma Storer, University Hospitals Case Medical Center; Vin Tangpricha, Emory University; Grace A McComsey, University Hospitals Case Medical Center
• Language: English
• Date: 2012-01-01
• Publisher: International Medical Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: ©2012 International Medical Press.
• Final Published Version (URL): http://dx.doi.org/10.3851/IMP1983
• Title of Journal or Parent Work: Antiviral Therapy
• ISSN: 1359-6535
• Volume: 17
• Issue: 4
• Start Page: 613
• End Page: 621
• Grant/Funding Information: This study was funded in part by a virology fellows grant from Bristol–Myers Squibb awarded to CTL; and by a grant from the University Hospitals Harrington-McLaughlin Heart and Vascular Institute.; Additional technical support was provided by the CWRU/UH Center for AIDS Research: NIH grant number P30 AI36219.
• Keywords: ANTIRETROVIRAL THERAPY; Life Sciences & Biomedicine; INTIMA-MEDIA THICKNESS; ASSOCIATION; Pharmacology & Pharmacy; Virology; Science & Technology; MORTALITY; CHOLECALCIFEROL; RISK-FACTORS; Infectious Diseases; 25-HYDROXYVITAMIN D; BLOOD-PRESSURE; INSULIN SENSITIVITY; ADULTS
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Virology; Health Sciences, Nutrition

Abstract

Background: Studies suggest that vitamin D deficiency is a risk factor for cardiovascular disease and diabetes. Vitamin D deficiency is prevalent in HIV patients but the effect of vitamin D supplementation on cardiovascular risk in this population is unknown. Methods: We conducted a randomized, double-blind, placebo-controlled trial among 45 HIV-infected adults in Cleveland (OH, USA) on stable antiretroviral therapy with durable virological suppression and a baseline serum 25-hydroxyvitamin D level of ≤20 ng/ml. Participants were randomized 2:1 to vitamin D3 4,000 IU daily or placebo for 12 weeks. The primary outcome was a change in flow-mediated brachial artery dilation (FMD). Results: Baseline demographics were similar except for age (vitamin D versus placebo, mean ±sd 47 ±8 versus 40 ±10 years; P=0.009). Both groups had reduced FMD at baseline (median values 2.9% [IQR 1.6-4.8] for vitamin D versus 2.5% [IQR 1.7-6.4] for placebo; P=0.819). Despite an increase in the concentration of serum 25-hydroxyvitamin D from baseline to 12 weeks (5.0 ng/ ml [IQR -0.9-7.4] versus -1.9 ng/ml [IQR -4.0-0.1] for vitamin D versus placebo, respectively; P=0.003), there was no difference in FMD change (0.55% [IQR -1.05- 2.13] versus 0.29% [IQR -1.61-1.77]; P=0.748). Vitamin D supplementation was associated with a decrease in total and non-high-density lipoprotein cholesterol, and an increase in indices of insulin resistance. Conclusions: Among HIV-infected individuals with vitamin D deficiency, supplementation with 4,000 IU vitamin D3 daily for 12 weeks modestly improved vitamin D status and cholesterol but worsened insulin resistance without change in endothelial function. The mechanisms of resistance to standard doses of vitamin D and the complex role of vitamin D in glucose metabolism in this population require further investigation.