Vitamin D and Immune Activation in Chronic HIV Infection

Risa Hoffman  
University of California, Los Angeles
Clinical Sciences

a) Research Question: This pilot study is intended to determine whether vitamin D deficiency leads to chronic inflammation in individuals with HIV who are successfully treated with anti-HIV medicines.  We will also determine whether restoring vitamin D levels to normal, in those patients with low vitamin D levels, can lead to decreased levels of inflammation.

(b) Specific Aims: (1) To compare levels of inflammation in HIV positive people on anti-HIV medicines, with low versus normal vitamin D levels, by measuring special blood tests and blood immune cell characteristics. (2) To compare these same blood inflammation tests in successfully treated HIV patients with vitamin D deficiency, before and after vitamin D levels are restored to normal.

(c) Background/Significance: Chronic blood inflammation has been shown to occur in people living with HIV, and this inflammation persists, even when patients are successfully treated with anti-HIV medicines. Chronic inflammation in the blood has been associated with damage to blood vessels and risk of damage to organs such as the heart, liver, and kidneys. This problem has stimulated intense interest in research that can improve our understanding of the causes of this persistent inflammation. Vitamin D deficiency occurs very commonly in individuals with HIV, and is most common among individuals with darker skin, such as Africa-American and Hispanic populations, minorities that contribute significantly to the pool of HIV-infected individuals in southern California. Additionally, vitamin D has been shown to play an important role in making the immune system work properly, and research studies have shown elevations in blood inflammation in non-HIV-infected individuals with low vitamin D levels. We propose this pilot study to determine whether HIV patients with vitamin D deficiency, who are successfully treated with ant-HIV medications, have higher levels of blood inflammation than similar HIV patients who do not have vitamin D deficiency, and whether inflammation can be decreased by giving vitamin D and returning the vitamin D level in the blood to normal.
(d) Approach or Methods, We propose to study HIV-infected patients who are successfully treated with ant-HIV medications (defined by low numbers of virus in the blood), with and without vitamin D deficiency. As part of routine primary care at the UCLA CARE center, individuals will have their vitamin D level checked. A total of 70 people with normal vitamin D levels (at or above 30 ng/ml) and 70 people with low (deficient) levels ( less than 30 ng/ml) will have blood collected and analyzed for inflammation levels. People with low vitamin D will be then followed for 12-24 weeks as they take vitamin D supplements. Upon documentation of a normal vitamin D level, blood tests will be repeated to assess for changes in the same blood inflammation markers measured before vitamin D was started.

(e) Impact /Expected Results: The goal of this work is to find a way to decrease chronic inflammation in HIV-infected patients successfully treated with anti-HIV medicines. Slowing or stopping chronic inflammation will lead to decreased damage to the blood vessels and protect major organs (heart, kidneys, liver). If vitamin D supplementation were found to decrease blood inflammation, giving daily vitamin D would be a simple, safe, and inexpensive way to improve health in people with HIV-infection.