HIV Linked to Vitamin D Deficiency

Understanding the Causes, Impact, and Treatment

Sun shining on woman's face
Sun shining on woman's face. Getty Images/Adam Hester/Blend Images

Vitamin D is an important nutrient for bone health, calcium balance, and immune function — yet it often found to be low in many people living with HIV. While the reasons for this could be many, it is clear that HIV infection, in and of itself, contributes to this and that continued deficiency could have negative impact on your long-term health.

Where Do We Get Our Vitamin D?

Vitamin D is one of the body's fat-soluble vitamins.

Unlike may other vitamins, it's only found in a few food sources  — like certain fish and fortified foods, such as milk and cereals. Most vitamin D is made in our body after sun exposure.

When our body's skin is exposed to the ultraviolet rays of sunlight, a cholesterol-like molecule is released into the bloodstream, making its way to the liver. Once in the liver, it's converted into 25-hydroxyvitamin D. This molecule then travels to the kidney where it is converted into 1,25 dihydroxyvitamin D, the active form of vitamin D.

A person can also get Vitamin D from supplements, either as a single vitamin or as part of a multivitamin. There are also vitamin D prescriptions given to certain patients with illnesses that predispose them to having low vitamin D levels. 

Why Do People Become Vitamin D Deficient?

There are a number of reasons why a person may have vitamin D deficiency. For some people, certain diseases are linked to the condition, like liver and kidney disease — since liver and kidney function are essential for the metabolism of vitamin D in the body.

Celiac disease, or other diseases that prevent proper absorption of vitamin D in the gut, can also cause vitamin D deficiency.

People who get little sunlight and/or have a diet poor in vitamin D may also develop vitamin D deficiency. This is especially common in elderly people who live in nursing homes.

 

Obesity and medications that affect the way vitamin D is made in the body, like certain anti-seizure medications, may also predispose a person to vitamin D deficiency.

What is the Connection Between HIV and Vitamin D Deficiency?

According to a 2012 study in the Journal of Antimicrobial Chemotherapy, over 85 percent of people with HIV have low vitamin D levels — the precise reason as to why this percentage is so high is unclear. 

In addition, there is scientific evidence showing that certain antiretroviral medications, interfere with the way Vitamin D is made in the body. This likely contributes to vitamin D deficiency in people infected with HIV. 

Of these, Sustiva (efavirenz) is considered a key suspect, as well as any combination drug (e.g., Atripla) which contains efavirenz. Currently, no other antiretroviral drug has demonstrated this level of association to vitamin D deficiency.

How Is Vitamin D Deficiency Diagnosed and Treated

 By measuring the amount of 25-hydroxyvitamin D in the blood, a doctor can determine if a person has enough vitamin D in their body.

Luckily, there is a relatively easy way to restore vitamin D supplies — by taking vitamin D supplements. A doctor can prescribe a dose that is appropriate for them — a common dose prescribed is 50,000 IU of vitamin D taken orally once each week for 8 weeks.

After restoring the vitamin D level, a doctor will typically prescribe a dose of 400 to 800 IU of vitamin D3 taken orally per day. Some experts suggest that higher doses of vitamin D are required each day to maintain a healthy balance.

Vitamin D repletion is typically recommended when 25-hydroxyvitamin D levels fall below 10 ng/ml.

It's important to  note that even though Vitamin D deficiency is linked to low sunlight, it's critical that a person protect themselves from harmful sun rays, as recommended by the American Academy of Dermatology. 

What Can I Do?

At your next doctor's visit, talk to him or her about vitamin D. Make certain that deficiency is not a problem for you, and that you are doing everything you can to maintain a healthy level of this important vitamin.If you are already taking any supplements, be sure to advise your doctor about this, as well as any other drug, prescription or not, you may be taking.

Sources:

Allavena C et al. "High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs". J Antimicrob Chemother. 2012 Sep;67(9):2222-30.

Cannell, JJ, Hollis BW, Zasloff M, Heaney RP. "Diagnosis and Treatment of Vitamin D deficiency".Expert Opin Pharmacother2008 Jan;9(1):107-18.

Pinzone MR. "Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic". Eur Rev Med Pharmacol Sci. 2013 May;17(9):1218-32.

Yin M. "Vitamin D, bone, and HIV infection." Top Antivir Med. 2012 Dec;20(5):168-72.

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