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Vitamin D insufficiency, deficiency common in children
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Vitamin D insufficiency and deficiency are common in children with HIV and children without HIV, according to recent study findings published in the Pediatric Infectious Disease Journal.
“Vitamin D status of HIV-infected children and young adults requires better assessment and [vitamin D insufficiency] should probably be actively treated in this population,” Candice Meyzer, MD, of Necker-Enfants Malades Hospital in Paris, and colleagues wrote. “Further investigations are required to identify effective approaches and doses. Current guidelines on vitamin D supplementation in France are unsatisfactory and should be reconsidered to ensure that children and adolescents maintain an adequate vitamin D status throughout the year.”
The prospective study included 113 children and young adults with HIV aged 24 years or younger and 54 healthy controls.
Researchers found that overall prevalence of vitamin D deficiency (VDD) was 38.9% and vitamin D insufficiency (VDI) was 58.7%. Those with HIV had higher mean serum 25-hydoxyvitamin D (25-[OH]D) concentrations compared with the control group. Dark phototype and age were significantly associated with low serum 25-(OH)D concentrations in participants with HIV, and dark phototype was the only independent risk factor of VDD in those with HIV (OR=14.6; 95% CI, 2.4-89.9). Participants receiving efavirenz were also more likely to have lower serum 25-(OH)D concentrations.
“In conclusion, VDI and VDD are highly prevalent in children and adolescents in our population during winter,” researchers wrote. “Because of the importance of vitamin D for overall health, and particularly innate immunity, poor vitamin D status may result in adverse health outcomes in pediatrics and especially for HIV-infected patients due to their unique risk profile.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopMichael T. Brady, MD
Vitamin D is a fat-soluble vitamin that plays an important role in absorption and metabolism of calcium and phosphorus. Sun exposure is also necessary for a chemical modification that results in the biologically active form of vitamin D. Vitamin D’s effects on calcium and phosphorus are involved in maintenance of healthy bones and in many important chemical reactions in the body. The role of vitamin D in maintaining health continues to expand, including effects on the immune system, maintaining a healthy weight, and severity of medical conditions such as asthma and rheumatoid arthritis, to name a few. In HIV-infected individuals, vitamin D deficiency has been associated with increased risk for cardiovascular disease in adults and greater immunosuppression and disease progression in HIV-infected children and adults.
The recent study by Meyzer and colleagues in The Pediatric Infectious Disease Journal notes a high rate of vitamin D insufficiency and vitamin D deficiency in HIV-infected children and non–HIV-infected control children in France. Since fortification of milk and other food with vitamin D is not common in France, the relevance of this study to an American population of HIV-infected children could be questioned. However, there are studies in the United States that provide similar evidence of vitamin D insufficiency/deficiency in American HIV-infected children despite fortification of milk and other foods with vitamin D in the United States (Eckard AR. AIDS Res Human Retroviruses. 2013;[published online ahead of print June 15]; Rutstein R. Clin Nutr. 2011;5:624-628).
While some of the reasons for low vitamin D levels in HIV-infected children may be due to suboptimal dietary vitamin D and sun exposure, there is also data suggesting that host genetic variants that alter availability and activity of vitamin D may also play a role in vitamin D levels and HIV disease progression in children (Moodley A. Pediatr Infect Dis J. 2013;[published online ahead of print June 3]).
HIV-infected children should be provided with optimized nutrition to address their need for adequate calories, vitamins and minerals. Nutritional status, including vitamin D levels, should be assessed if disease progression occurs despite appropriate and effective antiretroviral therapy.
Michael T. Brady, MD, can be reached at michael.brady@nationwidechildrens.org.
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