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Global health
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Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study
  1. Saurabh Mehta1,
  2. Ferdinand M Mugusi2,
  3. Ronald J Bosch3,
  4. Said Aboud4,
  5. Willy Urassa5,
  6. Eduardo Villamor6,
  7. Wafaie W Fawzi7
  1. 1Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
  2. 2Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
  3. 3Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
  5. 5Diagnostics and Laboratory Technology Team, World Health Organization, Geneva, Switzerland
  6. 6Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  7. 7Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Saurabh Mehta; smehta{at}cornell.edu

Abstract

Objectives Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status.

Design Cohort study.

Setting Outpatient clinics in Tanzania.

Participants 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) initiating anti-TB treatment at enrolment in a multivitamin supplementation (excluding vitamin D) trial (Clinicaltrials.gov identifier: NCT00197704).

Primary and secondary outcome measures Information on treatment outcomes such as failure and relapse, HIV disease progression, T-cell counts and anthropometry was collected routinely, with a median follow-up of 52 and 30 months for HIV-uninfected and HIV-infected patients, respectively. Cox and binomial regression, and generalised estimating equations were used to assess the association of vitamin D status with these outcomes.

Results Mean 25-hydroxyvitamin D concentrations at enrolment were 69.8 (±21.5) nmol/L (27.9 (±8.6) ng/mL). Vitamin D insufficiency (<75 nmol/L) was associated with a 66% higher risk of relapse (95% CI 4% to 164%; 133% higher risk in HIV-uninfected patients). Each unit higher 25-hydroxyvitamin D levels at baseline were associated with a decrease of 3 (p=0.004) CD8 and 3 (p=0.01) CD3 T-cells/µL during follow-up in patients with HIV infection. Vitamin D insufficiency was also associated with a greater decrease of body mass index (BMI; –0.21 kg/m2; 95% CI −0.39 to −0.02), during the first 8 months of follow-up. No association was observed for vitamin D status with mortality or HIV disease progression.

Conclusions Adequate vitamin D status is associated with a lower risk of relapse and with improved nutritional indicators such as BMI in patients with TB, with or without HIV infection. Further research is needed to determine the optimal dose of vitamin D and effectiveness of daily vitamin D supplementation among patients with TB.

  • HIV
  • Africa
  • Vitamin D

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003703

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