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Low vitamin D increased TB risk among those receiving ART
Vitamin D deficiency was associated with pulmonary tuberculosis, incident oral thrush, wasting and weight loss of more than 10% among adults with HIV receiving antiretroviral therapy, recent data suggest.
“Our data add to the evidence that vitamin D deficiency may be an important independent risk factor for pulmonary tuberculosis and other adverse outcomes for people with HIV,” Chris Sudfeld, a doctoral student at Harvard School of Public Health, told Infectious Disease News. “If randomized controlled trials determine that vitamin D supplementation is safe and effective in reducing mortality, pulmonary TB or other morbidities, we may have an additional, low-cost adjunct treatment to add to our toolkit for improving survival and/or quality of live for people with HIV starting ART.”
Chris Sudfeld
Sudfeld and colleagues conducted the first prospective study of vitamin D among adults with HIV receiving ART in sub-Saharan Africa. The study included 1,103 women and men with HIV who were randomly selected upon initiating ART in another clinical trial. The researchers measured vitamin D levels at baseline: 101 adults were vitamin D deficient, 481 were insufficient and 521 were sufficient. There were no differences in age, sex, CD4 count, HIV disease stage or other variables between the participants. The patients were then evaluated at monthly clinical examinations.
Forty-three patients were diagnosed with pulmonary tuberculosis. After multivariate adjustment, the HR was 2.89 for those who were vitamin D deficient. There was no difference between vitamin D sufficient and vitamin D insufficient adults. Oral thrush was present in 102 patients during follow-up, and the HR was 1.96 for those with vitamin D deficiency.
Sixty adults experienced wasting, and those with a vitamin D deficiency had an HR of 3.1 for wasting compared with those who were vitamin D sufficient. Lastly, adults with vitamin D deficiency were 2.1 times more likely to experience weight loss of 10% or more compared with those who had vitamin D sufficiency.
“The observational design of this study does not allow for determination of a causal effect and as a result, randomized controlled trials of vitamin D supplementation appear to be warranted for people with HIV initiating ART. Research examining the relationship of vitamin D with mortality, morbidity and development among HIV-infected children in resource-limited settings is also needed.”
Disclosure: Sudfeld reports no relevant financial disclosures.