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Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes.

Sloan DJ, Mwandumba HC, Kamdolozi M, Shani D, Chisale B, Dutton J, Khoo SH, Allain TJ, Davies GR - Int. J. Tuberc. Lung Dis. (2015)

Bottom Line: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART).Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019).Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.

View Article: PubMed Central - PubMed

Affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.

ABSTRACT

Setting: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment.

Objectives: To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment.

Design: A prospective longitudinal cohort study.

Results: The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART.

Conclusions: Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.

No MeSH data available.


Related in: MedlinePlus

Effect of seasonality on baseline serum 25(OH)D concentration. Serum 25(OH)D concentrations from the 166 patients with baseline data were lower in study participants recruited during or just after the cold season. The P value showing seasonal differences in serum 25(OH)D concentrations was derived from the Kruskal-Wallis test.
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i1027-3719-19-8-904-f03: Effect of seasonality on baseline serum 25(OH)D concentration. Serum 25(OH)D concentrations from the 166 patients with baseline data were lower in study participants recruited during or just after the cold season. The P value showing seasonal differences in serum 25(OH)D concentrations was derived from the Kruskal-Wallis test.

Mentions: The Table and Figure 3 show that, on multivariate analysis, the strongest factor associated with baseline vitamin D status was the month of recruitment; participants recruited in July/August or September/October had lower serum 25(OH)D than those recruited in January/February (P = 0.001 and P = 0.004, respectively). Lower 25(OD) also occurred in patients with food insecurity (P = 0.034) and those who regularly consumed alcohol (P = 0.019). There were trends towards lower concentrations in patients with lower BMI (P = 0.055) or who cooked indoors with biomass fuel (P = 0.066), but no relationships between vitamin D status and HIV infection parameters, CXR cavitation or baseline bacillary load.


Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes.

Sloan DJ, Mwandumba HC, Kamdolozi M, Shani D, Chisale B, Dutton J, Khoo SH, Allain TJ, Davies GR - Int. J. Tuberc. Lung Dis. (2015)

Effect of seasonality on baseline serum 25(OH)D concentration. Serum 25(OH)D concentrations from the 166 patients with baseline data were lower in study participants recruited during or just after the cold season. The P value showing seasonal differences in serum 25(OH)D concentrations was derived from the Kruskal-Wallis test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4497634&req=5

i1027-3719-19-8-904-f03: Effect of seasonality on baseline serum 25(OH)D concentration. Serum 25(OH)D concentrations from the 166 patients with baseline data were lower in study participants recruited during or just after the cold season. The P value showing seasonal differences in serum 25(OH)D concentrations was derived from the Kruskal-Wallis test.
Mentions: The Table and Figure 3 show that, on multivariate analysis, the strongest factor associated with baseline vitamin D status was the month of recruitment; participants recruited in July/August or September/October had lower serum 25(OH)D than those recruited in January/February (P = 0.001 and P = 0.004, respectively). Lower 25(OD) also occurred in patients with food insecurity (P = 0.034) and those who regularly consumed alcohol (P = 0.019). There were trends towards lower concentrations in patients with lower BMI (P = 0.055) or who cooked indoors with biomass fuel (P = 0.066), but no relationships between vitamin D status and HIV infection parameters, CXR cavitation or baseline bacillary load.

Bottom Line: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART).Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019).Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.

View Article: PubMed Central - PubMed

Affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.

ABSTRACT

Setting: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment.

Objectives: To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment.

Design: A prospective longitudinal cohort study.

Results: The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART.

Conclusions: Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.

No MeSH data available.


Related in: MedlinePlus