Hypothesis
Is vitamin D deficiency involved in the immune reconstitution inflammatory syndrome?
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* Corresponding author: Anali Conesa-Botella aconesa@itg.be
1 Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
2 Katholieke Universiteit Leuven, Laboratory of Experimental Medicine and, Endocrinology, Leuven, Belgium
3 University of Antwerp, Faculty of Medicine, Antwerp, Belgium
4 Université Libre de Bruxelles, Department of Nuclear Medicine, Brussels, Belgium
5 Institute of Tropical Medicine, Department of Immunology, Antwerp, Belgium
AIDS Research and Therapy 2009, 6:4 doi:10.1186/1742-6405-6-4
Published: 21 April 2009Abstract
Background
About 20–30% of persons with HIV infection, especially those living in countries with limited resources, experience an immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral treatment. The active form of vitamin D, 1,25-dihydroxyvitamin D, is a key player in the clearance of pathogens and influences the level of inflammation and macrophage activation.
Presentation of the hypothesis
We hypothesize that low availability of 1,25-dihydroxyvitamin D, either due to vitamin D deficiency or due to polymorphisms in the vitamin D receptor or in its activating/inactivating enzymes, contributes to the appearance of IRIS. Furthermore, drug interactions with the enzymatic pathways of vitamin D could favour the development of IRIS.
Testing the hypothesis
Our hypothesis could be explored by a case-control study to assess the prevalence of vitamin D deficiency in HIV-infected patients on antiretroviral treatment who develop and do not develop IRIS.
Implications of the hypothesis
If the role of vitamin D in IRIS is confirmed, we would be able to screen patients at risk for IRIS by screening for vitamin D deficiency. After confirmation by means of a clinical trial, vitamin D supplementation could be a cheap and safe way to reduce the incidence of IRIS.