Correlation of vitamin D levels and immune status in Hiv positive children aged 3 to 14 years attending Jaramogi Oginga Odinga teaching and referral hospital in Kisumu county, Kenya

Abstract

Vitamin D deficiency is a worldwide phenomenon and it’s more prevalent in Human Immunodeficiency Virus (HIV) positive individuals. This prevalence could be higher in children from sub-Saharan Africa where the HIV burden is highest. In Kenya the occurrence of Vitamin D deficiency has been reported among children, diabetics and cancer patients. Children are the worst affected by HIV because the disease progresses faster due to their naïve immune systems. Alongside other factors this is compounded by deficiency diseases, most notably Vitamin D(25OHD) which acts as an immunomodulator of the adaptive immune system where it directly affects T cell activation and antigen presenting cells. Vitamin D deficiency has been associated with poor clinical outcome among adults living with HIV. However, it is not clearly known how this would play out in children. This was a comparative cross-sectional studywhere98HIV positive children aged 3 to 14 years attending the Jaramogi Oginga Teaching and Referral Hospital and unmatched98HIV negative children in the same age visiting the outpatient clinic at the same hospital were consecutively sampled and differences in the Vitamin D levels determined using blood samples. Correlation was then done between Vitamin D,CD4 and viral load for the HIV positive group. Vitamin D was determined using the ELISA technique, while CD4 levels was determined using 3-colour flow cytometry. HIV viral load levels were determined by real-time PCR. Clinical history was collected from the participants medical records. Independent samples T-test was used to compare Vitamin D means while Pearson correlation was used to correlate Vitamin D, CD4 and viral load. The HIV uninfected group had mean Vitamin D levels of 30.88 ng/ml (30.88±6.62 ng/ml) with deficiency (<20 ng/ml) and insufficiency (21-29 ng/ml) rates at 5.1% and 37.8% respectively. The HIV infected group had mean Vitamin D levels of 28.21 ng/ml (28.21±6.39 ng/ml) with deficiency and insufficiency rates at 13.3% and 46.9% respectively. There was a significant difference between the mean Vitamin D levels of the two groups(p=0.004). There was no correlation between Vitamin D and CD4count (r=.166, N=98, p=0.101), and Vitamin D and viral load (r=-.115, N=98, p=0.776). In conclusion prevalence of Vitamin D deficiency and insufficiency is higher in HIV infected children than in uninfected children and there is no correlation between Vitamin D status and immune status in HIV infected children. These findings suggest the assessment of Vitamin Din children as the adverse health effects extend beyond bone health. Assessment of Vitamin D in this demographic could help improve the overall health status of children especially the immunosuppressed.