Effects of sunlight exposure and vitamin D supplementation on HIV patients

doi:10.1016/j.jsbmb.2020.105664

The Journal of Steroid Biochemistry and Molecular Biology

Volume 200, June 2020, 105664

https://doi.org/10.1016/j.jsbmb.2020.105664 Get rights and content

Highlights

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Vitamin D deficiency (VDD) is becoming common among HIV patients.
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Increase urbanization and decrease sunlight exposure are causing VDD.
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The lack of sufficient sunlight exposure might increases the risk of HIV.
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VDD can be a catalyst for the HIV-associated pathological processes.
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Optimal vitamin D intake and sunlight exposure are vital for HIV patients.

Abstract

Unlike many vitamins derived predominantly from food sources, vitamin D is produced endogenously in the skin upon exposure to sunlight. Ethnicity, skin pigmentation, socioeconomic status, geographic location, climate and sunscreen; all of these factors contribute to the amount of insolation for any given individual. Insufficient insolation creates the prerequisites for vitamin D deficiency. This is particularly true in HIV-infected individuals, who are highly vulnerable to vitamin D insufficiency/deficiency, as it plays a huge role in the musculoskeletal and cardiovascular systems. Antiretroviral therapy may also be a factor in vitamin D deficiency. Today, as the issues of preventing common skeletal and non-skeletal diseases with HIV-infected people are becoming highly relevant, the maintenance of vitamin D levels through exposure to sunlight or supplementation appears to be an effective and safe solution. This review focuses on studies concerning the potential role of vitamin D supplementation through adequate sunlight exposure or dietary intake in HIV-infected people. The biology and epidemiology of HIV infection, as well as the issues related to vitamin D deficiency, its status on immune function, the effect of vitamin D against HIV disease progression and other health aspects of this vitamin, are briefly explained.

Section snippets

Biology and pathogenesis of HIV

The human immunodeficiency virus (HIV) is classified in the Retroviridae family of retroviruses, and more specifically belongs to the Lentivirus genus. Two types of HIV have been intensively studied: HIV-1 and HIV-2 [1,2]. HIV-1, formally known as human T-lymphotropic virus 3/lymphadenopathy associated virus, HTLV-III/LAV, which is the most common and pathogenic type of HIV, initially described in 1983 [3,4]. The global HIV emergence is mainly due to the epidemic spread of HIV-1. In the

Vitamin D

Scientific understanding of the significance of vitamin D has expanded notably beyond the fact that it is necessary for proper assimilation of calcium and phosphorus for the formation and maintenance of healthy bones and teeth [25], particularly among aging adults [26]. In addition to the regulation of bone homeostasis, vitamin D plays important physiological roles in many non-skeletal processes, including regulation of the normal functions of the thyroid gland, blood clotting, providing muscle

Vitamin D and immune response

Vitamin D has a crucial regulatory effect on innate and adaptive immune responses. 1,25(OH)₂D₃ directly modulates the proliferation of T-lymphocytes, inhibits the development of Th17 cells, controls the differentiation of B cell precursors into plasma cells, prevents the production of Th1-associated cytokines and costimulatory molecules (CD40, CD80, and CD86), and stimulates the production of Th2 -associated cytokines. In particular, vitamin D supports antibacterial and antiviral immunity. In

HIV and Vitamin D

Vitamin D has been a focus for researchers pursuing an HIV cure in recent decades. In particular, a considerable amount of literature is available regarding the ability of vitamin D to influence the course of cardiovascular disease (CVD) under HIV [60,61], the virologic response in co-infection HIV/HCV [62,63], and formulated recommendations for the diagnosis, prevention, and treatment of vitamin D deficiency in HIV-positive patients. Here, we review the results of these various studies to

Effects of vitamin D supplementation on HIV-infected individuals

In 2015, the journal Clinical Infectious Diseases [70] published guidance for evaluation and management of bone disease in patients with HIV, as well as prevention following a fragility fracture. 34 HIV experts from 16 countries took part in this project, issuing recommendations based upon research findings. These experts were convinced that densitometry after 40 years should be a routine part of monitoring HIV-positive patients. The primary trigger for increased attention to bone mineral

Effect of sunlight exposure on HIV-infected individuals

Numerous studies provide evidence indicating that insufficient presence of vitamin D is characteristic of the majority of the population living in the temperate zone [95,96]. Between November and February, the entire area of the world above 42 °N is at risk for vitamin D insufficiency/deficiency. In many countries, vitamin D deficiency is registered in 30–50 % of both children and adults [97]. The lack of sufficient solar exposure significantly increases the risk of several diseases, including

Conclusion

Vitamin D is a group of biologically active substances, which play a role in controlling many pathways within the complex pathophysiology. While lack of this vitamin is a common problem among adults, for HIV-positive individuals, vitamin D insufficiency and deficiency lead to many health-related conditions, such as impaired calcium metabolism, cardiovascular diseases, insulin resistance, type II diabetes, oncopathology, dyslipidemia, decrease in cognitive functions, and decrease in immunity.

Acknowledgments

Thanks to Rufsa H. Afroze, and Andona Zacks-Jordan for carefully reading the manuscript and providing useful suggestions. Dr. Razzaque is a Visiting Professor at the Harvard School of Dental Medicine, Boston (USA), and an Honorary Professor at the University of Rwanda College of Medicine & Health Sciences in Kigali (Rwanda).

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Vitamin D is a fat soluble hormone that is majorly involved in the classical function of calcium and phosphorus hemostasis and bone mineralization as well non classical functions of immune modulation in various viral and autoimmune diseases. Both innate and adaptive immunity is aided by vitamin D. Deficiency of vitamin D is not only linked with bone and muscle disorders but it has a critical role in many infectious and noninfectious diseases. A growing body of literature suggests vitamin D deficiency in human immunodeficiency virus (HIV) infected patients. HIV affects 36.7 million people worldwide. Currently a valuation of 0.13 million people are infected with acquired immunodeficiency syndrome (AIDS) in Pakistan. Various studies showed that hypovitaminosis D may aggravate the disease severity in HIV patients by compromising the immune system. Calcidiol supplementation is credibly a promising adjuvant of combination anti-retroviral therapy (cART) for the treatment of HIV by increasing CD4 T-cells and lowering the viral load. This review accentuates vitamin D's functions as an immune modulator in HIV, the effect of hypovitaminosis D in diseases severity, and its supplementation impact on the treatment of HIV infected patients.
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ReviewEffects of sunlight exposure and vitamin D supplementation on HIV patients

Highlights

Abstract

Section snippets

Biology and pathogenesis of HIV

Vitamin D

Vitamin D and immune response

HIV and Vitamin D

Effects of vitamin D supplementation on HIV-infected individuals

Effect of sunlight exposure on HIV-infected individuals

Conclusion

Acknowledgments

Biophys. J.

Int. J. Infect. Dis.

Clin. Immunol. Immunopathol.

Mayo Clin. Proc.

Am. J. Med. Sci.

J. Steroid Biochem. Mol. Biol.

Am. J. Clin. Nutr.

Biochim Biophys Acta - Proteins Proteomics

Trends Biochem. Sci.

Adv. Nutr.

Steroids

Ann. Epidemiol.

Am. J. Clin. Nutr.

Vitam. Horm.

Clin. Nutr.

J. Steroid Biochem. Mol. Biol.

Mayo Clin. Proc.

J. Steroid Biochem. Mol. Biol.

J. Steroid Biochem. Mol. Biol.

Update on human immunodeficiency virus (HIV)-2 infection

Clin. Infect. Dis.

Comparing HIV-1 and HIV-2 infection: lessons for viral immunopathogenesis

Rev. Med. Virol.

Isolation of human T-cell leukemia virus in acquired immune deficiency syndrome (AIDS)

Science

Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS)

Science

Origins of HIV and the AIDS pandemic

Cold Spring Harb. Perspect. Med.

Isolation of a new human retrovirus from West African patients with AIDS

Science

Genome organization and transactivation of the human immunodeficiency virus type 2

Nature

German advisory committee blood (Arbeitskreis blut) S ‘Assessment of PT by B. Human immunodeficiency virus (HIV)

Transfus. Med. Hemother.

NMR observation of HIV-1 gp120 conformational flexibility resulting from V3 truncation

FEBS J.

Roles of microRNAs and long-noncoding RNAs in human immunodeficiency virus replication

Wiley Interdiscip. Rev. RNA

HIV interactions with monocytes and dendritic cells: viral latency and reservoirs

Retrovirology

Proviral load and immune function in blood and lymph node during HIV-1 and HIV-2 infection

Clin. Exp. Immunol.

Chemokine/CD4 receptor density ratios correlate with HIV replication in lymph node and peripheral blood of HIV-infected individuals

AIDS

1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults

MMWR Recomm reports Morb Mortal Wkly report Recomm reports.

Prevention of HIV infection

Indian Pediatr.

Survival of HIV-1 in syringes

J. Acquir. Immune Defic. Syndr. Hum. Retrovirol.

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J. Infect. Dis.

Inactivation of human T-lymphotropic virus type III/lymphadenopathy-associated virus by formaldehyde-based reagents

Appl. Environ. Microbiol.

Genomic human immunodeficiency virus type 1 RNA variation in mother and child following intra-uterine virus transmission

J. Gen. Virol.

Independent variation and positive selection in env V1 and V2 domains within maternal-infant strains of human immunodeficiency virus type 1 in vivo

J. Virol.

The essentials of HIV: a review for nurses

J. Infus. Nurs.

The vitamin D deficiency pandemic: a forgotten hormone important for health

Public Health Rev.

Role of vitamin D in adults requiring nutrition support

JPEN J. Parenter. Enteral Nutr.

The role of vitamin D in thyroid diseases

Int. J. Mol. Sci.

Vitamin D, thrombosis, and hemostasis: more than skin deep

Review
Effects of sunlight exposure and vitamin D supplementation on HIV patients