Tindall Alyssa M, Schall Joan I, Seme Boitshepo, Ratshaa Bakgaki, Tolle Michael, Nnyepi Maria S, Mazhani Loeto, Rutstein Richard M, Steenhoff Andrew P, Stallings Virginia A
Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
Botswana-UPenn Partnership, Gaborone, Botswana.
PLoS One. 2020 Aug 13;15(8):e0236510. doi: 10.1371/journal.pone.0236510. eCollection 2020.
Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. There is less evidence on prevalence of vitamin D deficiency and nutrition and growth in HIV-infected and -exposed children in low- and middle-income countries.
To determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and -infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth.
This was a cross-sectional study of HIV+ mothers and HIV-exposed infants and unrelated children (1-7.9 years). Serum 25-hydroxyvitamin D (25(OH)D) was measured, among other nutritional indicators, for mothers, infants and children. Vitamin D status for HIV-infected mothers and children, and an immune panel was assessed. History of HIV anti-retroviral medications and breastfeeding were obtained. Data were collected prior to universal combination antiretroviral therapy in pregnancy.
Mothers (n = 36) had a mean serum 25(OH)D of 37.2±12.4ng/mL; 11% had insufficient (<20ng/mL), 17% moderately low (20.0-29.9ng/mL) and 72% sufficient (≥30ng/mL) concentrations. No infants (n = 36) or children (n = 48) were vitamin D insufficient; 22% of HIV- and no HIV+ infants had moderately low concentrations and 78% of HIV- and 100% of HIV+ infants had sufficient status, 8% of HIV- and no HIV+ children had moderately low concentrations and 92% of HIV- and 100% HIV+ children had sufficient concentrations. HIV+ children had significantly lower length/height Z scores compared to HIV- children. Length/height Z score was positively correlated with serum 25(OH)D in all children (r = 0.33, p = 0.023), with a stronger correlation in the HIV+ children (r = 0.47 p = 0.021). In mothers, serum 25(OH)D was positively associated with CD4% (r = 0.40, p = 0.016).
Results showed a low prevalence of vitamin D insufficiency in Botswana. Growth was positively correlated with vitamin D status in HIV-exposed children, and HIV+ children had poorer linear growth than HIV- children.
维生素D水平低下是一个全球性的健康问题，在高收入国家的人类免疫缺陷病毒（HIV）感染者中很常见。在低收入和中等收入国家，关于HIV感染及暴露儿童维生素D缺乏症的患病率以及营养与生长情况的证据较少。
确定博茨瓦纳HIV感染母亲及其子女的维生素D水平，HIV感染母亲之间以及HIV暴露和感染的婴幼儿及儿童之间的差异，以及维生素D与疾病相关结局、营养和生长之间的关联。
这是一项针对HIV阳性母亲、HIV暴露婴儿及非相关儿童（1至7.9岁）的横断面研究。除其他营养指标外，还对母亲、婴儿和儿童测量了血清25-羟基维生素D（25(OH)D）。评估了HIV感染母亲和儿童的维生素D水平以及免疫指标。获取了HIV抗逆转录病毒药物治疗史和母乳喂养情况。数据收集于孕期普遍采用联合抗逆转录病毒治疗之前。
母亲（n = 36）的血清25(OH)D平均水平为37.2±12.4ng/mL；11%的母亲维生素D水平不足（<20ng/mL），17%的母亲为中度低下（20.0 - 29.9ng/mL），72%的母亲水平充足（≥30ng/mL）。没有婴儿（n = 36）或儿童（n = 48）维生素D水平不足；22%的HIV阴性和HIV阳性婴儿维生素D浓度为中度低下，78%的HIV阴性婴儿和100%的HIV阳性婴儿维生素D水平充足，8%的HIV阴性和HIV阳性儿童维生素D浓度为中度低下，92%的HIV阴性儿童和100%的HIV阳性儿童维生素D浓度充足。与HIV阴性儿童相比，HIV阳性儿童的身长/身高Z评分显著更低。在所有儿童中，身长/身高Z评分与血清25(OH)D呈正相关（r = 0.33，p = 0.023），在HIV阳性儿童中相关性更强（r = 0.47，p = 0.021）。在母亲中，血清25(OH)D与CD4%呈正相关（r = 0.40，p = 0.016）。
结果显示博茨瓦纳维生素D不足的患病率较低。在HIV暴露儿童中，生长与维生素D水平呈正相关，且HIV阳性儿童的线性生长比HIV阴性儿童更差。
