Influence of Vitamin D Deficiency on the Development of Opportunistic Infection in People Living with HIV/AIDS (PWHAs).

Background: It is known that vitamin D is associated with immune cell growth, and an association between vitamin D deficiency and development of chronic infections such as tuberculosis has been reported. However, there have been few studies concerning the association between vitamin D deficiency and opportunistic infection (OI) in people living with HIV/AIDS (PWHA).

Method: PWHAs who had vitamin D (25-OH vitamin D, 25OHD) test results from 2012 to 2017 were enrolled. All enrolled PWHAs were divided into a vitamin D-deficient group and non-deficient group according to the 25OHD cutoff set by ROC curve analysis. The rates of OIs were compared between the two groups.

Results: Among 440 enrolled PWHAs, 394 (89.5%) were male, 32 were ≥ 65 years (13.4%), 237 (53.9%) were ART-naïve, and 107 (24.3%) had CD4 + T cell < 200/L. Seventy-three cases of OIs occurred in 63 PWHAs (14.3%); the most common OI was tuberculosis (27, 6.1%) followed by pneumocystis pneumonia (PCP) (25, 5.7%), and Cytomegalovirus (CMV) diseases (10, 2.3%). In the ROC curve analysis, the AUC was 0.71 (95% CI 0.64- 0.79, P < 0.001) and the optimal cutoffs of 25OHD to predict OIs was 14 ng/mL.Overall OI development was significantly more prevalent in the vitamin D-deficiency group (aOR 3.05, 95% CI 1.43-6.48); tuberculosis (aOR 3.51, 95% CI 1.22-10.05) and CMV disease (aOR 10.13, 95% CI 1.11-92.03) were significantly associated with vitamin D deficiency, whereas PCP was not (aOR 1.32, 95% CI 0.44-3.98).

Conclusion: Stringent cutoffs of vitamin D deficiency (< 14 ng/mL) were well correlated with development of OIs in PWHAs. Vitamin D deficiency was associated with development of OIs, particularly tuberculosis and CMV infections.