article · British Journal Of Nutrition
This study examined the relationship between vitamin D and parathyroid hormone in adolescents living with HIV in Zambia and Zimbabwe. Enrolling 842 participants aged 11 to 19 years who had received antiretroviral therapy for at least six months, the research analysed blood levels of total 25-hydroxyvitamin D and intact parathyroid hormone alongside nutritional and health indicators. High rates of stunting and underweight were present, and three-quarters of the participants consumed less than 150 milligrams of calcium daily. An inverse, non-linear relationship emerged between total vitamin D and parathyroid hormone, with the relationship flattening at a vitamin D concentration of 74.6 nanomoles per litre. This pattern remained consistent regardless of whether participants took tenofovir disoproxil fumarate or had unsuppressed viral loads. In populations with very low habitual calcium intakes, achieving vitamin D concentrations above 75 nanomoles per litre may be necessary to support bone health.
Adolescents living with HIV often face nutritional vulnerabilities and risks to long-term skeletal health. Understanding the threshold where vitamin D effectively stabilises parathyroid hormone helps clinicians and public health programmes set informed nutritional benchmarks. In regions where dietary calcium intake is critically low, identifying precise vitamin D targets is essential for designing targeted nutritional guidelines and interventions to protect bone development during vital growth years.
This research provides clinical and nutritional data that could inform dietary supplementation strategies, nutritional guidelines, or therapeutic formulations targeting bone health in adolescents with HIV. The primary users would be healthcare providers, public health policymakers, and medical nutrition developers. The findings represent early-stage observational research, and further clinical studies are required before practical interventions or commercial nutritional products can be formally validated.
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Abstract Low vitamin D associated with high parathyroid hormone (PTH) is common in HIV infection. We determined the association between total 25(OH)D and PTH in adolescents living with HIV, in Zambia and Zimbabwe. Adolescents (11–19 years) perinatally infected with HIV and established on antiretroviral therapy for ≥ 6 months were recruited into a cross-sectional study. Socio-demographic and clinical characteristics were recorded, anthropometry measured and fasted serum concentrations of 1,25(OH) 2 D, total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression. 842 participants (female: 53·2%) with a median age of 15·5 (IQR: 13·2–17·9) years were enrolled. Median antiretroviral therapy duration was 9·8 (IQR: 6·3–12·3) years, and 165/841 had an HIV viral-load >60 copies/ml. Stunting (height-for-age z-score <–2) and underweight (weight-for-age z-score <–2) were observed in 29·9 and 30·0%, respectively. Three-quarters reported daily Ca intakes <150 mg/d. The mean ( sd ) concentrations of total 25(OH)D and 1,25(OH) 2 D were 66·1(16·5) nmol/l and 210·6 (70·4) pmol/l, respectively, and median PTH level was 4·3 (IQR: 3·3–5·5) pmol/l. There was an inverse non-linear relationship between total 25(OH)D and PTH, 25(OH)D levelling off at 74·6 nmol/l (95 % CI: 74·5, 75·2). Results were consistent in those taking tenofovir disoproxil fumarate and virally unsuppressed participants. In this population with extremely low habitual Ca intakes, the lack of association between 25(OH)D and PTH when 25(OH)D exceeded 75 nmol/l potentially suggests that levels of 25(OH)D >75 nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies.
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DOI: 10.1017/s0007114525000509
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