Vitamin D and calcium levels in Ugandan adults with human immunodeficiency virus and tuberculosis

Abstract

SUMMARY BACKGROUND Vitamin D increases cathelicidin production, and might alter mortality due to tuberculosis (TB) in human immunodeficiency virus (HIV) co-infection. However, due to abundant sun exposure, vitamin D levels might be excellent among Ugandans with HIV and TB. METHODS We measured 25(OH)D and calcium levels in 50 HIV-negative, 50 HIV-infected and 50 TB-HIV co-infected Ugandan adults. RESULTS Mean ± standard deviation 25(OH)D levels were 26 ± 7 ng/ml in HIV-negative, 28 ± 11 ng/ml in HIV-infected and 24 ± 11 ng/ml in TB-HIV co-infected adults (P > 0.05 all comparisons). Vitamin D deficiency (<12 ng/ml) was present in 10% of the HIV-infected subjects, 12% of the TB-HIV co-infected and none of the healthy controls (P = 0.03 for healthy vs. TB, P > 0.05 for other comparisons); 20% of the healthy controls, 22% of the HIV-positive and 38% of the TB-HIV co-infected subjects (P = 0.047 for healthy vs. TB, P > 0.05 for other comparisons) had suboptimal vitamin D levels (<20 ng/ml). No participant had hypercalcemia. Serum 25(OH)D levels correlated positively with body mass index (r = 0.22, P = 0.03) and serum calcium levels (r = 0.18, P = 0.03). CONCLUSIONS Ugandan HIV-infected adults with and without TB commonly had suboptimal vitamin D levels. Clinical trials are needed to evaluate the effect of vitamin D on health outcomes in HIV-infected patients with low vitamin D levels.

Vitamin D deficiency and the risk of tuberculosis: a meta-analysis

“…1,2,4,5,11,12,14,23,28,30,32–37,39,40–43,46,47 Our analysis showed that VDD was significantly associated with an increased risk of TB (OR =2.57; 95% CI =[1.74, 3.80]; P <0.00001; I 2 =83) (Figure 2B). Subgroup analysis revealed similar result for the Asian population (OR =2.62; 95% CI =[1.63, 4.23]; P <0.0001; I 2 =71); however, VDD was not associated with an increased risk of TB in the African population (OR =1.89; 95% CI =[0.82, 4.33]; P =0.13; I 2 =91) (Figure 2B).…”

“…1,4,5,11,12,14,22–28,30,35–44,46 Our analysis with a random-effect model showed a significantly lower serum/plasma 25(OH)D level in TB patients vs controls (MD =−13.05; 95% CI=[−19.02, −7.08]; P <0.0001; I 2 =96) (Figure 2A). Subgroup analysis showed similar result for the Asian population (MD =−14.64; 95% CI =[−20.15, −9.13]; P <0.00001; I 2 =89); however, there was no such significant difference for the African population (MD =−6.05; 95% CI =[−20.54, −8.43]; P =0.41; I 2 =98) (Figure 2A).…”

“…From a total of 723 potentially eligible articles, 685 were excluded because they were irrelevant to our topic here, reviews, meeting abstracts, or case-only studies, or contained no detailed data needed for our meta-analysis. A total of 38 articles were included in our meta-analysis 1,2,4,5,11,12,14,22–52…”

“…An additional analysis was also performed on the effect of anti-TB treatment on vitamin D level in TB subjects for the same purpose. Third, since human immunodeficiency virus (HIV)-infected subjects are more susceptible to TB and have greater mortality and morbidity caused by TB,14 to further clarify whether vitamin D played any role in occurrence and deterioration of TB in HIV-infected subjects, we also analyzed the association between vitamin D level/VDD and TB in HIV-infected subjects and the association between vitamin D level and risk of developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIV-TB-coinfected patients receiving antiretroviral therapy (ART). Finally, although serum 25(OH)D is the commonly used measure of vitamin D status in a subject,7 1,25(OH)2D3 is the actual bioactive form of vitamin D that induces antimicrobial response,7 and so we also performed a meta-analysis on the association between 1,25(OH)2D3 and TB in order to determine whether there was any change of 1,25(OH)2D3 level in TB subjects compared to control without TB.…”

Paradoxical TB-IRIS in HIV-infected Adults: a Systematic Review and Meta-analysis

“…It has been proposed that vitamin D deficiency may predispose to TB-IRIS [67] and this would then place those at higher latitudes at greater risk of TB-IRIS. However, studies to date have not confirmed an association between baseline vitamin D status and IRIS risk [68,69].…”