Vitamin D Status and Carotid Intima-Media Thickness in Adults Living with HIV Infection

Abstract

<p> Background: Vitamin D activity is important for the functioning of a broad range of body systems. Some of these, including the skeletal, immune, and cardiovascular systems, are particularly relevant in the management of HIV-infection; thus, and in consideration of evidence that factors associated with the scenario of HIV-infection can disrupt vitamin D metabolism, the assessment of vitamin D status in people living with HIV-infection may be particularly important. In this thesis, I address cardiovascular implications of vitamin D status in HIV-infection. More specifically, and based on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease (CVD), I hypothesized that in HIV-positive adults low 25-hydroxyvitamin D (25(0H)D) concentration would be associated with increased subclinical vascular disease as measured by carotid intima-medial thickness (IMT).</p> <p> Methods: Using regression analyses I cross-sectionally studied the relationship between 25(0H)D and carotid IMT in 283 participants of the Canadian HIV Vascular Study, a prospective study of CVD risk among HIV-positive Canadians.</p> <p> Results: The prevalence of vitamin D deficiency in the Canadian HIV Vascular study was surprisingly low. Plasma 25(0H)D by quartile was not associated with carotid IMT. However, in restricted cubic spline regression analyses designed to accommodate non-linearity there was evidence of an inverted U-shaped 25(0H)D-carotid IMT relationship. In exploratory regression models restricted to participants comprising the suboptimal range of vitamin D status, lower 25(0H)D concentration was statistically significantly associated with lower carotid IMT after adjustment for known CVD risk factors and other variables hypothesized to potentially confound a 25(0H)D-carotid IMT association.</p> <p> Main implication: While inference from these exploratory findings requires cautious interpretation, future investigations into the relationship between vitamin D status and vascular disease should consider the problem of non-linearity as a feature of primary analyses; otherwise, such studies might fail to detect a true association.</p>