Most Kids With HIV Need High Doses of Vitamin D

August 19, 2011

By C. Vidya Shankar MD

NEW YORK (Reuters Health) Aug 18 - The vast majority of HIV positive children have insufficient or deficient vitamin D levels, a new report shows -- and the authors say these kids need twice the standard treatment dose to achieve adequate levels.

But vitamin D supplementation, regardless of dosage, doesn't affect their HIV status, according to Dr. Ari Bitnun from the Hospital for Sick Children, Toronto and colleagues. CD4 percent and CD4 count held steady even when vitamin D levels improved.

The vitamin D deficiency is probably multifactorial, the researchers say. Along with too little sunlight exposure, sunscreen use, and low dietary intake, "recent data suggests that antiretroviral medication may adversely impact serum 25 hydroxy vitamin D levels," they said in an August 5th online paper in the Journal of Pediatrics.

"The key issue is being aware that vitamin D status is an issue and having a standard approach is important," Dr. Bitnun told Reuters Health by email. His paper notes that HIV patients are at particular risk for bone problems.

At this point, he said, "We are recommending vitamin D for all of our children. Whether this is applicable to other setting is an open question. I would expect this would hold for other northern communities at least."

Dr. Bitnun and colleagues studied 53 HIV positive children with a mean age of 10.3 years. Ten (19%) had severe HIV symptoms, 17 were severely immunosuppressed, and 39 were taking antiretroviral drugs.

Overall, 85% were vitamin D insufficient or deficient, with 25(OH)D cutoffs of 75 nmol/L for insufficiency and 25 nmol/L for deficiency.

The researchers divided them into three groups for the six-month study. Seventeen children received no intervention. Eighteen children received the standard vitamin D dose of 5600 U/week, and another 18 received twice that, or 11,200 U/week. Vitamin D was administered weekly.

At baseline, the mean CD4 count was 927 cells/microliter, the log10 viral load was 1.63, and the 25(OH)D level was 53.1 nmol/L.

CD4 levels and viral loads remained unchanged in all of the groups after the six-month study, the researchers report.

On the other hand, the mean 25(OH)D level more than doubled with treatment. It rose from 42.7 to 96.5 nmol/L in children who received the double dose of vitamin D; in that group the mean level was significantly greater than in the other groups.

Over two-thirds in the double-dose group had achieved satisfactory 25(OH)D levels after six months, vs. only a third of patients in the standard dose group.

The researchers say achieving and maintaining adequate vitamin D levels in HIV patients is "especially relevant in the context of HIV infection where, over time, bone health is recognized to be impaired with an increased risk of fracture."

They add, "We suggest that for children and adults with HIV infection, and perhaps other chronic medical conditions, higher doses may be warranted."

SOURCE: http://bit.ly/qF8E7j

J Pediatr 2011.

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