Association of high serum vitamin D concentrations with active pulmonary TB in an HIV co-endemic setting, Harare, Zimbabwe

Musarurwa, Cuthbert; Zijenah, Lynn S.; Duri, Doreen Zvipo; Mateveke-Dangaiso, Kudzie; Mhandire, Kudakwashe; Chipiti, Maria Mary; Munjoma, Marshall; Mujaji, WB

doi:10.1186/s12879-017-2243-x

Cited by 9 publications

(12 citation statements)

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“…Similarly to other reports, we found that vitD 3 levels in Ethiopians were not influenced by HIV status [ 6 , 35 , 41 , 44 ]. It has previously been described that a high proportion of TB/HIV co-infected South African patients were VDD and severe VDD was more common compared with active TB in HIV-negative patients, although VDD was associated with an enhanced TB susceptibility in both HIV-negative and HIV-positive individuals [ 31 ].…”

Section: Discussionsupporting

confidence: 90%

“…Another study from Guinea-Bissau [ 38 ] found that VDD was not more frequent in PTB patients than in healthy controls, but the mean 25(OH)D 3 concentration remained lower. Importantly, mean 25(OH)D 3 concentrations varied significantly in these studies from 30–83 nmol/L and severe VDD (<25 nmol/L) was rare in most of these populations [ 35 , 36 , 38 ]. Combined, these studies support the assumption that active TB is associated with vitD 3 status and that individuals with VDD are at higher risk to develop the disease [ 28 ].…”

Section: Discussionmentioning

confidence: 91%

“…In addition, sputum-conversion after two months of standard anti-TB treatment was less likely in children with intrathoracic TB (PTB and/or pleural TB) who were VDD or vitD 3 insufficient compared to vitD 3 sufficient children [ 34 ]. In contrast, studies from Zimbabwe [ 35 ], Gambia [ 36 ] and Tanzania [ 37 ] demonstrated that PTB patients with a relatively low proportion of VDD, had higher vitD 3 levels than non-TB controls. Another study from Guinea-Bissau [ 38 ] found that VDD was not more frequent in PTB patients than in healthy controls, but the mean 25(OH)D 3 concentration remained lower.…”

Section: Discussionmentioning

confidence: 98%

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Vitamin D3 Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis

et al. 2018

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Low vitamin D (vitD3) is one of the most common nutritional deficiencies in the world known to be associated with numerous medical conditions including infections such as tuberculosis (TB). In this study, vitD3 status and its association with the antimicrobial peptide, human cathelicidin (LL-37), was investigated in Ethiopian patients with different clinical forms of TB. Patients with active TB (n = 77) and non-TB controls (n = 78) were enrolled in Ethiopia, while another group of non-TB controls (n = 62) was from Sweden. Active TB included pulmonary TB (n = 32), pleural TB (n = 20), and lymph node TB (n = 25). Concentrations of 25-hydroxyvitamin D3 (25(OH)D3) were assessed in plasma, while LL-37 mRNA was measured in peripheral blood and in samples obtained from the site of infection. Median 25(OH)D3 plasma levels in active TB patients were similar to Ethiopian non-TB controls (38.5 versus 35.0 nmol/L) and vitD3 deficiency (<50 nmol/L) was common in both groups (73%). Ethiopians (low latitude) had significantly lower 25(OH)D3 levels compared with Swedish non-TB controls (51.0 nmol/L, high latitude), but vitD3 status was not affected by tuberculin-positivity or HIV infection. Patients with local lymph node TB had significantly higher 25(OH)D3 levels compared with pulmonary TB patients (48.0 versus 29.0 nmol/L). Moreover, plasma 25(OH)D3 levels correlated with local LL-37 expression in granulomatous lesions in TB infected lymph nodes. Instead, systemic LL-37 mRNA expression in blood cells was elevated compared with the site of infection in pulmonary and pleural TB. Low vitD3 status may be associated with an enhanced peripheral expression of LL-37 in patients with intrathoracic TB that could result from chronic inflammation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 98%

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Vitamin D3 Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis

et al. 2018

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“…Our results contribute to a small but growing pool of studies that refute the commonly accepted hypothesis that lower serum 25(OH) D concentrations are associated with PTB [ 10 , 15 , 16 , 19 , 22 ]. In the present study, median serum 25(OH) D concentrations for both the HIV + /PTB + and HIV + /PTB − groups were above the threshold for VDD but still below the cut-off for optimum serum 25(OH) D concentration.…”

Section: Discussionsupporting

confidence: 60%

Higher serum 25-hydroxyvitamin D concentrations are associated with active pulmonary tuberculosis in hospitalised HIV infected patients in a low income tropical setting: a cross sectional study

et al. 2018

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BackgroundThe inherent risk of developing tuberculosis (TB) in HIV- infected individuals is further enhanced by hypovitaminosis D. Interventions that offset HIV-associated immune deterioration potentially arrest disease progression and incidence of opportunistic infections including TB. Despite conflicting reports on association between vitamin D deficiency (VDD) and risk of TB, vitamin D (VD) supplementation remains a promising intervention.MethodsWe conducted a comparative cross-sectional study on 145 HIV+/pulmonary TB+ (PTB) and 139 HIV+/PTB− hospitalised patients to investigate association of vitamin D status and risk of PTB. Stratified random sampling was used to select archived serum specimens from participants enrolled in a randomised controlled trial (RCT) conducted to investigate the impact of using a point-of-care urine lipoarabinomannan strip test for TB diagnosis. PTB status was confirmed using sputum smear microscopy, culture or GeneXpert MTB/RIF. Serum 25-hydroxyvitamin D [25(OH) D] concentrations were assayed by competitive chemiluminescent immunoassay prior to commencement of anti-TB treatment. Effect of VD status on duration of hospital stay and patient outcomes on follow up at 8 weeks were also investigated. Median serum 25(OH) D concentrations were compared using Mann-Whitney test and covariates of serum VD status were assessed using logistic regression analysis.ResultsOverall VDD prevalence in the cohort was 40.9% (95% CI: 35.1–46.8). Median serum 25(OH)D concentrations were significantly higher in HIV+/PTB+ group (25.3 ng/ml, IQR:18.0–33.7) compared to the HIV+/PTB− group (20.4 ng/ml, IQR:14.6–26.9), p = 0.0003. Patients with serum 25(OH) D concentration ≥ 30 ng/ml were 1.9 times more likely to be PTB+ compared to those with serum 25(OH) D concentrations < 30 ng/ml (odds ratio (OR) 1.91; 95% CI 1.1–3.2). PTB-related death was associated with higher odds of having 25(OH) D levels≥30 ng/ml. Age, gender, CD4+ count, combination antiretroviral therapy (cART) status, efavirenz based cART regimen and length of hospital stay were not associated with vitamin D status.ConclusionsThe finding of an association between higher serum 25(OH) D concentrations and active PTB and TB-related mortality among hospitalised HIV-infected patients in the present study is at variance with the commonly reported association of hypovitaminosis and susceptibility to TB. Our findings though, are in concordance with a small pool of reports from other settings.

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“…There are many contentious reports showing association between vitamin D levels and tuberculosis [32, 33]. One recent study has reported the association of higher levels of vitamin D with active tuberculosis [34]. We suggest that sun exposure is the main source of vitamin D and most of the leprosy patients studied here having agricultural background were usually exposed to sun.…”

Section: Discussionmentioning

confidence: 62%

VDR polymorphism, gene expression and vitamin D levels in leprosy patients from North Indian population

et al. 2018

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BackgroundLeprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves. Vitamin D receptor (VDR) gene polymorphism has been found to be associated with leprosy. Vitamin D has been shown to control several host immunomodulating properties through VDR gene. Vitamin D deficiency was also found to be linked to an increased risk for several infections and metabolic diseases.ObjectiveIn the present study, we investigated the association of VDR gene polymorphism, mRNA gene expression of VDR and the vitamin D levels with leprosy and its reactional states.MethodologyA total of 305 leprosy patients consisting of tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL), lepromatous leprosy (LL), as well as 200 healthy controls were enrolled in the study. We identified single nucleotide polymorphisms (SNPs) of VDR Taq1, Fok1 and Apa1, as well as the expression of VDR mRNA gene using PCR-based restriction fragment length polymorphism (RFLP) analysis and real-time PCR respectively. We also performed ELISA to measure vitamin D levels.ResultWe observed that SNP of VDR gene (Fok1 and Taq1) are associated with the leprosy disease. The allelic frequency distribution of T and t allele (p = 0.0037), F and f allele (p = 0.0024) was significantly higher in leprosy patients and healthy controls. ff genotype of Fok1 was found to be associated with leprosy patients [p = 0.0004; OR (95% CI) 3.148 (1.662–5.965)]. The recessive model of Fok1 genotype was also found to be significantly associated in leprosy patients in comparison to healthy controls [p = 0.00004; OR (95% CI) 2.85 (1.56–5.22)]. Leprosy patients are significantly associated with t-F-a haplotype. Further, VDR gene expression was found to be lower in non-reaction group compared to that of reaction group of leprosy and healthy controls. Paradoxically, we noted no difference in the levels of vitamin D between leprosy patients and healthy controls.ConclusionBlood levels of vitamin D do not play any role in clinical manifestations of any forms of leprosy. ff genotype of Fok1 and tt genotype of Taq1 was found to be associated with leprosy per se. Association of t-F-a haplotype with leprosy was found to be significant and could be used as a genetic marker to identify individuals at high risk for developing leprosy. VDR gene expression was lower in TT/BT and BL/LL groups of leprosy in comparison to that of healthy controls.

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Association of high serum vitamin D concentrations with active pulmonary TB in an HIV co-endemic setting, Harare, Zimbabwe

Cited by 9 publications

References 35 publications

Vitamin D3 Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis

Vitamin D3 Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis

Higher serum 25-hydroxyvitamin D concentrations are associated with active pulmonary tuberculosis in hospitalised HIV infected patients in a low income tropical setting: a cross sectional study

VDR polymorphism, gene expression and vitamin D levels in leprosy patients from North Indian population

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