Simon Collins, HIV i-Base

Although the interpretation of the role HIV and vitamin D deficiency remains a focus in HIV-positive populations in relation to reductions in bone mineral density in adults, the impact on children is potentially more worrying.  If HIV-related complications prevent optimum bone development earlier in life (generally until the age of 30), this could result in higher rates of bone complication in later in life.

Atkinson and colleagues presented results of such low vitamin D levels in HIV-positive children that suggest further research should be an urgent priority.

An audit of plasma bone biochemistry, 25(OH) vitamin D and PTH levels in a cohort of 131 HIV-positive children receiving routine clinical care at a single UK centre between January and December 2009.  Median age was 12 years (IQR 9, 15); 51% were female and 85% were African/Caribbean. Median CD4 count (%) was 760 (32%) and 104 children (79%) were on HAART.

64 children (49%) were deficient (defined as 25nmol/L) and a further 37 (28%) had insufficient levels (25-50nmol/L). Abnormal PTH (>6.8 pmol/L) was seen in 15/52 children who had these levels (28.9%).

In multivariate analysis 25(OH) vitamin D deficiency was associated with older age (p=0.001), African/Caribbean ethnicity (p=0.04), winter season (0.008) and NNRTI use (P=0.01).

The authors concluded that Vitamin D deficiency and insufficiency is very common in children with HIV. Maximising bone health is increasingly important as this population enter adult life and the role of vitamin D supplementation requires further elucidation.

Ref: Atkinson S et al. Vitamin D deficiency in children with perinatally acquired HIV-1 infection living in the UK. 2nd Joint Conference of BHIVA with BASHH, 20–23 April 2010, Manchester. Poster abstract P159.

http://www.aegis.org/conferences/BHIVA/2010/16BHIVA-2010.pdf