Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e121-e126 (doi:10.1542/10.1542/peds.2008-0176)
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ARTICLE

Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents

Stephen M. Arpadi, MDa,b,c,d, Donald McMahon, MSe, Elaine J. Abrams, MDc,f, Marukh Bamji, MDg, Murli Purswani, MDh, Ellen S. Engelson, EdDd,e, Mary Horlick, MDb and Elizabeth Shane, MDe

a College of Physicians and Surgeons, Sergievsky Center
b Department of Pediatrics
e Department of Medicine
c Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
f Harlem Hospital Center, New York, New York
d St Luke's-Roosevelt Hospital Center, New York, New York
g Metropolitan Hospital Center, New York, New York
h Bronx-Lebanon Hospital Center, Bronx, New York

OBJECTIVE. Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period.

METHODS. HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly.

RESULTS. No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration <20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of ≥30 ng/mL compared with 3 (11.1%) in the placebo group.

CONCLUSIONS. Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.

Key Words: HIV • cholecalciferol • vitamin D • 25-hydroxyvitamin D • calcium • randomized, controlled trial

Abbreviations: 25-OHD—25-hydroxyvitamin D • VD+—cholecalciferol and calcium supplementation group • VD–—placebo group • Uca—urinary calcium excretion

Accepted Sep 12, 2008.


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