Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study
Identifieur interne : 002514 ( Ncbi/Merge ); précédent : 002513; suivant : 002515Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study
Auteurs : Saurabh Mehta [États-Unis] ; Ferdinand M. Mugusi ; Ronald J. Bosch [États-Unis] ; Said Aboud ; Willy Urassa [Suisse] ; Eduardo Villamor [États-Unis] ; Wafaie W. Fawzi [États-Unis]Source :
- BMJ Open [ 2044-6055 ] ; 2013.
Abstract
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.
Cohort study.
Outpatient clinics in Tanzania.
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).
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.
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.
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.
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DOI: 10.1136/bmjopen-2013-003703
PubMed: 24247327
PubMed Central: 3840339
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Mugusi</name><affiliation><nlm:aff id="af2"><addr-line>Department of Internal Medicine</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></nlm:aff><wicri:noCountry code="nlm country">United Republic of Tanzania</wicri:noCountry></affiliation></author><author><name sortKey="Bosch, Ronald J" sort="Bosch, Ronald J" uniqKey="Bosch R" first="Ronald J" last="Bosch">Ronald J. Bosch</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Biostatistics</addr-line>,<institution>Harvard School of Public Health</institution>,<addr-line>Boston, Massachusetts</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Aboud, Said" sort="Aboud, Said" uniqKey="Aboud S" first="Said" last="Aboud">Said Aboud</name><affiliation><nlm:aff id="af4"><addr-line>Department of Microbiology and Immunology</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></nlm:aff><wicri:noCountry code="nlm country">United Republic of Tanzania</wicri:noCountry></affiliation></author><author><name sortKey="Urassa, Willy" sort="Urassa, Willy" uniqKey="Urassa W" first="Willy" last="Urassa">Willy Urassa</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Diagnostics and Laboratory Technology Team</addr-line>,<institution>World Health Organization</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Villamor, Eduardo" sort="Villamor, Eduardo" uniqKey="Villamor E" first="Eduardo" last="Villamor">Eduardo Villamor</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Department of Epidemiology</addr-line>,<institution>University of Michigan School of Public Health</institution>,<addr-line>Ann Arbor, Michigan</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W" last="Fawzi">Wafaie W. 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Mugusi</name><affiliation><nlm:aff id="af2"><addr-line>Department of Internal Medicine</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></nlm:aff><wicri:noCountry code="nlm country">United Republic of Tanzania</wicri:noCountry></affiliation></author><author><name sortKey="Bosch, Ronald J" sort="Bosch, Ronald J" uniqKey="Bosch R" first="Ronald J" last="Bosch">Ronald J. Bosch</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Biostatistics</addr-line>,<institution>Harvard School of Public Health</institution>,<addr-line>Boston, Massachusetts</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Aboud, Said" sort="Aboud, Said" uniqKey="Aboud S" first="Said" last="Aboud">Said Aboud</name><affiliation><nlm:aff id="af4"><addr-line>Department of Microbiology and Immunology</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></nlm:aff><wicri:noCountry code="nlm country">United Republic of Tanzania</wicri:noCountry></affiliation></author><author><name sortKey="Urassa, Willy" sort="Urassa, Willy" uniqKey="Urassa W" first="Willy" last="Urassa">Willy Urassa</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Diagnostics and Laboratory Technology Team</addr-line>,<institution>World Health Organization</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Villamor, Eduardo" sort="Villamor, Eduardo" uniqKey="Villamor E" first="Eduardo" last="Villamor">Eduardo Villamor</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Department of Epidemiology</addr-line>,<institution>University of Michigan School of Public Health</institution>,<addr-line>Ann Arbor, Michigan</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W" last="Fawzi">Wafaie W. Fawzi</name><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>Departments of Global Health and Population</addr-line>,<institution>Nutrition, and Epidemiology, Harvard School of Public Health</institution>,<addr-line>Boston, Massachusetts</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>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.</p></sec><sec><title>Design</title><p>Cohort study.</p></sec><sec><title>Setting</title><p>Outpatient clinics in Tanzania.</p></sec><sec><title>Participants</title><p>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).</p></sec><sec><title>Primary and secondary outcome measures</title><p>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.</p></sec><sec><title>Results</title><p>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/m<sup>2</sup>; 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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chaisson, Re" uniqKey="Chaisson R">RE Chaisson</name></author><author><name sortKey="Martinson, Na" uniqKey="Martinson N">NA Martinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martineau, Ar" uniqKey="Martineau A">AR Martineau</name></author><author><name sortKey="Nhamoyebonde, S" uniqKey="Nhamoyebonde S">S Nhamoyebonde</name></author><author><name sortKey="Oni, T" uniqKey="Oni T">T Oni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martineau, Ar" uniqKey="Martineau A">AR Martineau</name></author><author><name sortKey="Timms, Pm" uniqKey="Timms P">PM Timms</name></author><author><name sortKey="Bothamley, Gh" uniqKey="Bothamley 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id><journal-id journal-id-type="hwp">bmjopen</journal-id><journal-id journal-id-type="publisher-id">bmjopen</journal-id><journal-title-group><journal-title>BMJ Open</journal-title></journal-title-group><issn pub-type="epub">2044-6055</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24247327</article-id><article-id pub-id-type="pmc">3840339</article-id><article-id pub-id-type="publisher-id">bmjopen-2013-003703</article-id><article-id pub-id-type="doi">10.1136/bmjopen-2013-003703</article-id><article-categories><subj-group subj-group-type="heading"><subject>Global Health</subject><subj-group><subject>Research</subject></subj-group></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject><subject>1699</subject><subject>1706</subject><subject>1842</subject><subject>1714</subject><subject>1692</subject><subject>1731</subject></subj-group></article-categories><title-group><article-title>Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mehta</surname><given-names>Saurabh</given-names></name><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-3788-0665</contrib-id><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Mugusi</surname><given-names>Ferdinand M</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bosch</surname><given-names>Ronald J</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Aboud</surname><given-names>Said</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Urassa</surname><given-names>Willy</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Villamor</surname><given-names>Eduardo</given-names></name><xref ref-type="aff" rid="af6">6</xref></contrib><contrib contrib-type="author"><name><surname>Fawzi</surname><given-names>Wafaie W</given-names></name><xref ref-type="aff" rid="af7">7</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Division of Nutritional Sciences</addr-line>,<institution>Cornell University</institution>,<addr-line>Ithaca, New York</addr-line>,<country>USA</country></aff><aff id="af2"><label>2</label><addr-line>Department of Internal Medicine</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></aff><aff id="af3"><label>3</label><addr-line>Department of Biostatistics</addr-line>,<institution>Harvard School of Public Health</institution>,<addr-line>Boston, Massachusetts</addr-line>,<country>USA</country></aff><aff id="af4"><label>4</label><addr-line>Department of Microbiology and Immunology</addr-line>,<institution>Muhimbili University of Health and Allied Sciences</institution>,<addr-line>Dar es Salaam</addr-line>,<country>United Republic of Tanzania</country></aff><aff id="af5"><label>5</label><addr-line>Diagnostics and Laboratory Technology Team</addr-line>,<institution>World Health Organization</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></aff><aff id="af6"><label>6</label><addr-line>Department of Epidemiology</addr-line>,<institution>University of Michigan School of Public Health</institution>,<addr-line>Ann Arbor, Michigan</addr-line>,<country>USA</country></aff><aff id="af7"><label>7</label><addr-line>Departments of Global Health and Population</addr-line>,<institution>Nutrition, and Epidemiology, Harvard School of Public Health</institution>,<addr-line>Boston, Massachusetts</addr-line>,<country>USA</country></aff><author-notes><corresp><label>Correspondence to</label> Dr Saurabh Mehta; <email>smehta@cornell.edu</email></corresp></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>16</day><month>11</month><year>2013</year></pub-date><volume>3</volume><issue>11</issue><elocation-id>e003703</elocation-id><history><date date-type="received"><day>1</day><month>8</month><year>2013</year></date><date date-type="rev-recd"><day>29</day><month>9</month><year>2013</year></date><date date-type="accepted"><day>14</day><month>10</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access"><license-p>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: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bmjopen-2013-003703.pdf"></self-uri><self-uri content-type="draft-revisions-pdf" xlink:type="simple" xlink:href="bmjopen-2013-003703.draft_revisions.pdf"></self-uri><self-uri content-type="reviewers-comments-pdf" xlink:type="simple" xlink:href="bmjopen-2013-003703.reviewer_comments.pdf"></self-uri><abstract><sec><title>Objectives</title><p>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.</p></sec><sec><title>Design</title><p>Cohort study.</p></sec><sec><title>Setting</title><p>Outpatient clinics in Tanzania.</p></sec><sec><title>Participants</title><p>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).</p></sec><sec><title>Primary and secondary outcome measures</title><p>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.</p></sec><sec><title>Results</title><p>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/m<sup>2</sup>; 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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>Africa</kwd><kwd>Vitamin D</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Suisse</li><li>États-Unis</li></country></list><tree><noCountry><name sortKey="Aboud, Said" sort="Aboud, Said" uniqKey="Aboud S" first="Said" last="Aboud">Said Aboud</name><name sortKey="Mugusi, Ferdinand M" sort="Mugusi, Ferdinand M" uniqKey="Mugusi F" first="Ferdinand M" last="Mugusi">Ferdinand M. Mugusi</name></noCountry><country name="États-Unis"><noRegion><name sortKey="Mehta, Saurabh" sort="Mehta, Saurabh" uniqKey="Mehta S" first="Saurabh" last="Mehta">Saurabh Mehta</name></noRegion><name sortKey="Bosch, Ronald J" sort="Bosch, Ronald J" uniqKey="Bosch R" first="Ronald J" last="Bosch">Ronald J. Bosch</name><name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W" last="Fawzi">Wafaie W. Fawzi</name><name sortKey="Villamor, Eduardo" sort="Villamor, Eduardo" uniqKey="Villamor E" first="Eduardo" last="Villamor">Eduardo Villamor</name></country><country name="Suisse"><noRegion><name sortKey="Urassa, Willy" sort="Urassa, Willy" uniqKey="Urassa W" first="Willy" last="Urassa">Willy Urassa</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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