Accelerated CD4+ T-cell recovery following vitamin D supplementation in a virologically suppressed adult living with HIV - A Case Report

Abstract

Background: Immune non-response despite sustained HIV viral suppression remains a clinical challenge. We report a patient with a prolonged plateau in CD4 count who experienced a marked rise following correction of vitamin D insufficiency. Case presentation: A 48-year-old man with chronic HIV infection, fully adherent to antiretroviral therapy and virologically suppressed for at least two years (2022-2024), developed disseminated osteoarticular tuberculosis involving the left hip and shoulder. After completing prolonged anti- tuberculosis therapy, his viral load remained suppressed (40 copies/mL) but CD4 count plateaued at 426 cells/mm3. Serum 25-hydroxyvitamin D was 25 ng/mL (insufficient). Vitamin D3 60,000 IU weekly was initiated. After six months, CD4 count increased to 1,071 cells/mm3 while viral suppression was maintained, with no change in antiretroviral regimen or other concurrent therapies. Conclusion: Vitamin D supplementation temporally coincided with accelerated CD4 recovery in a virologically suppressed patient with prior poor immunological recovery. Causality cannot be inferred from a single case; controlled studies are required to clarify whether vitamin D repletion benefits immune non-responders.