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Accepted manuscript

The association between 25-hydroxyvitamin D and parathyroid hormone in adolescents living with HIV in southern Africa: a cross sectional study

Published online by Cambridge University Press:  13 March 2025

Tafadzwa Madanhire Open the ORCID record for Tafadzwa Madanhire [Opens in a new window] ,
Kate A Ward ,
Amy MacDougall ,
Nuredin I Mohammed ,
Lackson Kasonka ,
Hildah B Mabuda ,
Molly Chisenga ,
Jonathan C. Y. Tang ,
William D Fraser  and
Tsitsi Bandason
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Tafadzwa Madanhire*
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
Kate A Ward
Affiliation:
MRC Lifecourse Epidemiology Centre, Human Development and Health, University of Southampton, Southampton, UK
Amy MacDougall
Affiliation:
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
Nuredin I Mohammed
Affiliation:
MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK. Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
Lackson Kasonka
Affiliation:
University Teaching Hospital, Lusaka, Zambia
Hildah B Mabuda
Affiliation:
University Teaching Hospital, Lusaka, Zambia
Molly Chisenga
Affiliation:
University Teaching Hospital, Lusaka, Zambia
Jonathan C. Y. Tang
Affiliation:
Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK Clinical Biochemistry, Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
William D Fraser
Affiliation:
Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK Clinical Biochemistry, Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
Tsitsi Bandason
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
Nyasha V Dzavakwa
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Victoria Simms
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Rashida A Ferrand
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Celia L Gregson
Affiliation:
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe Global Musculoskeletal Research Group, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol
*
Corresponding author: Tafadzwa Madanhire: Address: Biomedical Research and Training Institute, 10 Seagrave Road, Harare, Zimbabwe Email: Tafadzwa.Madanhire@lshtm.ac.uk Telephone: +263 242336691
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Abstract

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Low vitamin D associated with high parathyroid hormone (PTH) is commonly reported in the context of HIV infection. We determined the association between total 25-hydroxyvitamin-D [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 (ART) 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-dihydroxyvitamin-D (1,25(OH)2D), total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression modelling. 842 participants (female: 53.2%) with median age 15.5 (IQR:13.2-17.9) years were enrolled. Median ART duration was 9.8 [IQR:6.3-12.3] years and 165/841 (19.6%) had an HIV viral load >60copies/ml. Stunting (HAZ score<-2) and underweight (WAZ score<-2) were observed in 29.9% and 30.0% respectively. Three quarters (n=639) reported daily calcium intakes <150mg/day. The mean (SD) concentrations of total 25(OH)D and 1,25(OH)2D 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 74.6nmol/L (95%CI: 74.5-75.2). Results were consistent in those taking tenofovir disoproxil fumarate (81.7%) and in those who were virally unsuppressed. In this population with extremely low habitual calcium intakes, the lack of association between 25(OH)D and PTH when 25(OH)D exceeded 75nmol/L, potentially suggests levels of 25(OH)D >75nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies.

Keywords

Vitamin Dparathyroid hormoneadolescentAfricaHIV
Type
Research Article
Information
British Journal of Nutrition , Accepted manuscript , pp. 1 - 33
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society