Associations between 25-Hydroxyvitamin D and Immunologic, Metabolic, Inflammatory Markers in Treatment-Naive HIV-Infected Persons: The ANRS CO9 «COPANA» Cohort Study

<div><p>Objectives</p><p>Low 25(OH)D has been associated with dyslipidemia, insulin resistance and inflammation in both general and HIV-infected (mostly treated) populations. We investigated these associations in antiretroviral-naïve HIV-infected persons.</p><p>Design</p><p>We measured plasma 25(OH)D, metabolic, immunologic and inflammatory markers in 355 persons (204 Whites, 151 Blacks) at enrollment in the ANRS COPANA cohort.</p><p>Methods</p><p>25(OH)D levels were categorized <10 ng/mL (severe deficiency) and <20 ng/mL (deficiency). Statistical analyses were adjusted for sampling season, ethnicity and the interaction between season and ethnicity.</p><p>Results</p><p>25(OH)D insufficiency (<30 ng/mL), deficiency (<20 ng/mL) and severe deficiency (<10 ng/mL) were highly prevalent (93%, 67% and 24% of patients, respectively). Blacks had significantly lower 25(OH)D than Whites (median: 13 <i>vs.</i> 17 ng/mL, <i>P</i><0.001), with markedly less pronounced seasonal variation. Smoking and drinking alcohol were associated with having a 25 OHD level<10 ng/mL. In patients with 25(OH)D<10 ng/mL, the proportion of persons with a CD4 count<100/mm³ was higher than in patients with 25(OH)D≥10 ng/mL (18.8% <i>vs.</i> 10.7%, <i>P</i> = 0.04). Persons with 25 OHD<10 ng/mL had higher levels of hsCRP (1.60 mg/L [IQR: 0.59–5.76] <i>vs.</i> 1.27 mg/L [0.58–3,39], <i>P</i> = 0.03) and resistin (16.81 ng/L [IQR: 13.82–25.74] <i>vs.</i> 11.56 ng/L [IQR: 8.87–20.46], <i>P</i> = 0.02), and, among Blacks only, sTNFR2 (2.92 ng/mL [2.31–4.13] <i>vs.</i> 2.67 ng/mL, [1.90–3.23], <i>P</i> = 0.04). The strength and significance of the association between CD4<100/mm³ and 25 OHD<10 ng/mL were reduced after adjustment on sTNFR1, sTNFR2, and hsCRP levels. In multivariate analysis, a CD4 count <100/mm³, resistin concentration and smoking were independently associated with 25(OH)D<10 ng/mL.</p><p>Conclusions</p><p>Severe vitamin D deficiency was associated with low CD4 counts and increased markers of inflammation in ARV-naïve HIV-infected persons.</p>