Vitamin D status and incidence of tuberculosis among contacts of pulmonary tuberculosis patients

Arnedo-Pena, Alberto; Juan-Cerdán, J V; Romeu-Garcia, Angeles; García-Ferrer, Daniel; Holguín-Gómez, R; Iborra-Millet, Jesus; Gil-Fortuño, M; Gomila-Sard, Bárbara; Roach-Poblete, Freddy

doi:10.5588/ijtld.14.0348

Cited by 23 publications

(21 citation statements)

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“…Although this finding can reflect a state of ill health or wasting secondary to a chronic infection [32] it may also support the hypothesis that low VD levels confers higher risk of progression from LTBI to active TB [33]. Consistent with our findings, other authors have shown that hypovitaminosis D can be regularly found in subjects with active TB.…”

Section: Discussionsupporting

confidence: 91%

“…Recently, Arnedo-Pena et al . showed in a prospective cohort study a significant inverse association between VD status at baseline and TB incidence at long term follow up (HR 0.88, 95% CI 0.80–0.97), although no further VD measurements were done beyond baseline [33]. In Pakistan, a cohort study of HHC of pulmonary TB patients also found that VD deficiency was a risk factor for developing active TB (RR 5.1 95% CI 1.2–21.3) [36].…”

Section: Discussionmentioning

confidence: 99%

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Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts

et al. 2017

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ObjectivesVitamin D (VD) enhances the immune response against Mycobacterium tuberculosis in vitro, and VD deficiency has been described in patients with active tuberculosis (TB). However, the role of hypovitaminosis D in the pathogenesis of early TB infection acquisition is unclear. We aimed to evaluate the association of VD deficiency, season of the year, and latent TB infection in household contacts (HHC), given that this is a potentially modifiable condition often related to nutritional deficiencies and lack of sun exposure.MethodsWe prospectively enrolled new pulmonary TB cases (n = 107) and their HHC (n = 144) over a 2-year period in Santiago, Chile. We compared plasma 25-hydroxycholecalciferol (25OHD) levels and examined the influence of season, ethnic background, living conditions, and country of origin.ResultsOver 77% of TB cases and 62.6% of HHC had VD deficiency (<20 ng/ml). Median 25OHD concentration was significantly lower in TB cases than in HHC (11.7 vs. 18.2 ng/ml, p<0.0001). Migrants HHC had lower 25OHD levels than non-migrants (14.6 vs. 19.0 ng/ml, p = 0.026), and a trend towards a higher burden of latent TB infection (52.9% vs. 35.2%, p = 0.066). Multivariate analysis found VD deficiency in HHC was strongly associated with being sampled in winter/spring (adOR 25.68, 95%CI 7.35–89.7), corresponding to the seasons with lowest solar radiation exposure. Spring enrollment–compared with other seasons–was the chief risk factor for latent TB infection in HHC (adOR 3.14, 95%CI 1.28–7.69).ConclusionsHypovitaminosis D was highly prevalent in TB cases and also in HHC. A marked seasonality was found for both VD levels and latent TB in HHC, with winter being the season with lowest VD levels and spring the season with the highest risk of latent TB infection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts

et al. 2017

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“…Finally, 15 articles published from 1985 through 2014 were included for further analysis. [ 6 – 10 , 20 – 29 ] These 15 eligible studies included 1440 cases and 2558 controls. Eight [ 6 – 10 , 20 – 22 ] of them only involved Asian participants and two [ 23 , 24 ] only involved African subjects.…”

Section: Resultsmentioning

confidence: 99%

A Serum Vitamin D Level <25nmol/L Pose High Tuberculosis Risk: A Meta-Analysis

Zeng

Yang

et al. 2015

PLoS ONE

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BackgroundLow serum Vitamin D is considered to be associated with tuberculosis while the “dangerous” level was not clear. The aim of this study was to identify the association between tuberculosis and serum Vitamin D levels via synthesis of available evidence.MethodsA search of EMBASE, Medline, ISI Web of knowledge, and Pubmed was conducted. The number of subjects of tuberculosis and no-tuberculosis groups in four Vitamin D range. Meta-analyses were performed and presented by odds ratios (ORs) and corresponding 95% confidence intervals (CIs).ResultsA total of 15 studies involving 1440 cases and 2558 controls were included. A significantly increased risk of tuberculosis was found in two ranges: ≤ 12.5 nmol/L: pooled OR = 4.556, 95% CI = 2.200-9.435; 13-25 nmol/L: pooled OR = 3.797, 95% CI = 1.935-7.405. No statistically significant risk of tuberculosis was found in the range of 26–50 nmol/L (pooled OR = 1.561, 95% CI =0.997-2.442). In range 51–75 nmol/L, no positive association was found (pooled OR =1.160, 95% CI = 0.708-1.900).ConclusionsThis study found that a serum Vitamin D level ≤ 25 nmol/L was significantly associated with an increased risk of tuberculosis while the range of 51–75 nmol/L was not. The range 26-50nmol/L posed potential high tuberculosis risk. Future large-scale, well-designed studies are needed to verify these results.

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“…Our finding further indicates that severe vitamin D deficiency in HIV patients is a risk factor for the development of active TB. [40,43] …”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

et al. 2016

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Initiation of efavirenz-based combination antiretroviral therapy (cART) is associated with Vitamin D deficiency, but the risk factors including efavirenz pharmacokinetics for cART-induced severe vitamin D deficiency (SVDD) and the impact of anti-tuberculosis (TB) cotreatment are not explored. We investigated the prevalence of SVDD in HIV and TB-HIV coinfected patients and associated risk factors for treatment-induced SVDD.Treatment-naïve Ethiopian HIV patients with (n = 102) or without (n = 89) TB co-infection were enrolled prospectively and received efavirenz-based cART. In TB-HIV coinfected patients, rifampicin-based anti-TB treatment was initiated 4 or 8 weeks before starting cART. Plasma 25-hydroxyvitamin D (25 [OH]D), cholesterol and 4-beta hydroxycholesterol concentrations were measured at baseline, 4th, 16th, and 48th week of cART. Plasma efavirenz concentrations were determined at 4th and 16th weeks of cART.TB-HIV patients had significantly lower plasma 25 (OH)D3 levels than HIV-only patients at baseline. TB co-infection, low Karnofsky score, high viral load, and high CYP3A activity as measured by plasma 4β-hydroxycholesterol/cholesterol ratios were significant predictors of low 25 (OH)D3 levels at baseline. In HIV-only patients, initiation of efavirenz-based cART increased the prevalence of SVVD from 27% at baseline to 76%, 79%, and 43% at 4th, 16th, and 48th weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by −40%, −50%, and −14% at 4th, 16th, and 48th weeks of cART, respectively.In TB-HIV patients, previous anti-TB therapy had no influence on 25 (OH)D3 levels, but the initiation of efavirenz-based cART increased the prevalence of SVDD from 57% at baseline to 70% and 72% at the 4th and 16th weeks of cART, respectively. Median plasma 25 (OH)D3 declined from baseline by −17% and −21% at week 4 and 16 of cART, respectively.Our results indicate low plasma cholesterol, high CYP3A activity, and high plasma efavirenz concentrations as significant predictors of early efavirenz-based cART-induced vitamin D deficiency. Low plasma 25 (OH)D3 level at baseline is associated with TB co-infection and HIV diseases progression. Initiation of efavirenz-based cART is associated with high incidence of SVDD, whereas rifampicin based anti-TB therapy co-treatment has no significant effect. Supplementary vitamin D during cART initiation may be beneficial for HIV patients regardless of TB coinfection.

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Vitamin D status and incidence of tuberculosis among contacts of pulmonary tuberculosis patients

Cited by 23 publications

References 0 publications

Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts

Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts

A Serum Vitamin D Level <25nmol/L Pose High Tuberculosis Risk: A Meta-Analysis

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

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