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Open Access Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes

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SETTING: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment.

OBJECTIVES: To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment.

DESIGN: A prospective longitudinal cohort study.

RESULTS: The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART.

CONCLUSIONS: Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.
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Keywords: HIV; antiretroviral therapy; relapse; seasonality; treatment failure

Document Type: Research Article

Affiliations: 1: *Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi, Liverpool Heart and Chest Hospital, Liverpool, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, §Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi 2: *Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, §Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi 3: §Department of Microbiology, College of Medicine, University of Malawi, Blantyre 4: *Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi 5: #University of East Anglia, Norwich 6: **Department of Pharmacology, University of Liverpool, Liverpool 7: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi 8: *Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi, Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi, ††Institute of Infection and Global Health, University of Liverpool, United Kingdom

Publication date: August 1, 2015

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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