1
|
Levin MJ, Ginde AA, Schmid DS, Lang N, Canniff J, Schwartz RS, Weinberg A. Effect of high dose vitamin D supplementation on subsequent immune responses to administration of the live herpes zoster vaccine to long-term care residents. Vaccine 2024; 42:2278-2281. [PMID: 38423817 DOI: 10.1016/j.vaccine.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Thirty-three long-term care residents (mean age 76.5 years), who were participating in a study in which they were randomized to receive either oral daily standard dose (400-1000 IU/day) 25-hydroxy vitamin D (vitamin D3) (SD) or high dose (3000-4000 IU/day) (HD) vitamin D3, were vaccinated with the live, attenuated herpes zoster vaccine. Blood was drawn at vaccination and three weeks later to determine varicella-zoster virus (VZV) antibody and T-cell mediated immune responses. ELISA and neutralizing antibodies increased significantly, but to the same extent, in both groups. The antibody avidity significantly increased from pre- to post-vaccination only in the HD group. VZV-CMI, as measured by FLUOROSPOT significantly increased post-vaccination in both groups, but the difference in interferon-γ spot-forming cells (SFC) and interleukin-2 SFC was lower in the HD than SD group. The increase in VZV-CMI correlated inversely with circulating regulatory T cells in the HD group. We conclude that pre-treatment with HD vitamin D3 does not appreciably enhance the antibody response to a live vaccine and that VZV-CMI responses were diminished in HD vitamin D3 recipients.
Collapse
Affiliation(s)
- Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - D Scott Schmid
- University of Colorado, Boulder, CO, United States; Previously Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nancy Lang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jennifer Canniff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert S Schwartz
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO, United States
| | - Adriana Weinberg
- Departments of Pediatrics, Medicine, and Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
2
|
Obeagu EI, Obeagu GU, Ukibe NR, Oyebadejo SA. Anemia, iron, and HIV: decoding the interconnected pathways: A review. Medicine (Baltimore) 2024; 103:e36937. [PMID: 38215133 PMCID: PMC10783375 DOI: 10.1097/md.0000000000036937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
This review delves into the intricate relationship between anemia, iron metabolism, and human immunodeficiency virus (HIV), aiming to unravel the interconnected pathways that contribute to the complex interplay between these 3 entities. A systematic exploration of relevant literature was conducted, encompassing studies examining the association between anemia, iron status, and HIV infection. Both clinical and preclinical investigations were analyzed to elucidate the underlying mechanisms linking these components. Chronic inflammation, a hallmark of HIV infection, disrupts iron homeostasis, impacting erythropoiesis and contributing to anemia. Direct viral effects on bone marrow function further compound red blood cell deficiencies. Antiretroviral therapy, while essential for managing HIV, introduces potential complications, including medication-induced anemia. Dysregulation of iron levels in different tissues adds complexity to the intricate network of interactions. Effective management of anemia in HIV necessitates a multifaceted approach. Optimization of antiretroviral therapy, treatment of opportunistic infections, and targeted nutritional interventions, including iron supplementation, are integral components. However, challenges persist in understanding the specific molecular mechanisms governing these interconnected pathways. Decoding the interconnected pathways of anemia, iron metabolism, and HIV is imperative for enhancing the holistic care of individuals with HIV/AIDS. A nuanced understanding of these relationships will inform the development of more precise interventions, optimizing the management of anemia in this population. Future research endeavors should focus on elucidating the intricate molecular mechanisms, paving the way for innovative therapeutic strategies in the context of HIV-associated anemia.
Collapse
Affiliation(s)
| | | | - Nkiruka Rose Ukibe
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Samson Adewale Oyebadejo
- Department of Biomedical Laboratory Sciences, Faculty of Fundamental Applied Sciences, Institut d’ Enseignement Superiuor de Ruhengeri (INES-RUHENGERI), Musanze District, Northern Region, Rwanda
| |
Collapse
|
3
|
VanValkenburg A, Kaipilyawar V, Sarkar S, Lakshminarayanan S, Cintron C, Prakash Babu S, Knudsen S, Joseph NM, Horsburgh CR, Sinha P, Ellner JJ, Narasimhan PB, Johnson WE, Hochberg NS, Salgame P. Malnutrition leads to increased inflammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis. Front Immunol 2022; 13:1011166. [PMID: 36248906 PMCID: PMC9554585 DOI: 10.3389/fimmu.2022.1011166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Most individuals exposed to Mycobacterium tuberculosis (Mtb) develop latent tuberculosis infection (LTBI) and remain at risk for progressing to active tuberculosis disease (TB). Malnutrition is an important risk factor driving progression from LTBI to TB. However, the performance of blood-based TB risk signatures in malnourished individuals with LTBI remains unexplored. The aim of this study was to determine if malnourished and control individuals had differences in gene expression, immune pathways and TB risk signatures. Methods We utilized data from 50 tuberculin skin test positive household contacts of persons with TB - 18 malnourished participants (body mass index [BMI] < 18.5 kg/m2) and 32 controls (individuals with BMI ≥ 18.5 kg/m2). Whole blood RNA-sequencing was conducted to identify differentially expressed genes (DEGs). Ingenuity Pathway Analysis was applied to the DEGs to identify top canonical pathways and gene regulators. Gene enrichment methods were then employed to score the performance of published gene signatures associated with progression from LTBI to TB. Results Malnourished individuals had increased activation of inflammatory pathways, including pathways involved in neutrophil activation, T-cell activation and proinflammatory IL-1 and IL-6 cytokine signaling. Consistent with known association of inflammatory pathway activation with progression to TB disease, we found significantly increased expression of the RISK4 (area under the curve [AUC] = 0.734) and PREDICT29 (AUC = 0.736) progression signatures in malnourished individuals. Conclusion Malnourished individuals display a peripheral immune response profile reflective of increased inflammation and a concomitant increased expression of risk signatures predicting progression to TB. With validation in prospective clinical cohorts, TB risk biomarkers have the potential to identify malnourished LTBI for targeted therapy.
Collapse
Affiliation(s)
- Arthur VanValkenburg
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, United States
- Bioinformatics Program, Boston University, Boston, MA, United States
| | - Vaishnavi Kaipilyawar
- Department of Medicine, Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Chelsie Cintron
- Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Senbagavalli Prakash Babu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Selby Knudsen
- Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - C. Robert Horsburgh
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Pranay Sinha
- Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Jerrold J. Ellner
- Department of Medicine, Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Prakash Babu Narasimhan
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - W. Evan Johnson
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, United States
- Bioinformatics Program, Boston University, Boston, MA, United States
| | - Natasha S. Hochberg
- Department of Medicine, Boston Medical Center, Boston, MA, United States
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Padmini Salgame
- Department of Medicine, Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ, United States
- *Correspondence: Padmini Salgame,
| |
Collapse
|
4
|
Buyukdemirci S, Oguz EG, Cimen SG, Sahin H, Cimen S, Ayli MD. Vitamin D deficiency may predispose patients to increased risk of kidney transplant rejection. World J Transplant 2022; 12:299-309. [PMID: 36187881 PMCID: PMC9516489 DOI: 10.5500/wjt.v12.i9.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin D deficiency occurs in more than 80% of kidney transplant recipients. Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy (CAN). This study determined the association between serum 25 (OH) vitamin D, biopsy-proven allograft rejection, and CAN rates.
AIM To determine the relationship between serum 25 (OH) vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.
METHODS Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included. Recipients requiring graft biopsy due to declined function, hematuria, and proteinuria were reviewed. The two groups were compared regarding collected data, including the biopsy results, immunologic parameters, vitamin D, parathyroid hormone (PTH), phosphorus, albumin levels, and graft function tests.
RESULTS Fifty-two recipients who underwent graft biopsy met the inclusion criteria. In all, 14 recipients had a vitamin D level > 15 ng/mL (group 1) vs ≤ 15 ng/mL (group 2) in 38. In total, 27 patients had biopsy-proven rejection, and 19 had CAN. There was only 1 recipient with biopsy-proven rejection in group 1, whereas there were 24 patients with rejection in group 2. The rejection rate was significantly higher in group 2 than in group 1 (P < 0.001). Four patients were diagnosed with CAN in group 1 vs fifteen in group 2. There was no significant difference in the CAN rate between the two groups. PTH was higher at the time of graft biopsy (P = 0.009, P = 0.022) in group 1 with a mean of 268 pg/mL. Donor-specific antibodies were detected in 14 (56.0%) of the recipients with rejection. Vitamin D level was 9.7 ± 3.4 ng/mL in the rejection group vs 14.7 ± 7.2 in the non-rejection group; this difference was statistically significant (P = 0.003). The albumin levels were significantly lower in patients with rejection than in those without rejection (P = 0.001). In univariate regression analysis of risk factors affecting rejection, sex, serum vitamin D, phosphorus and albumin were found to have an impact (P = 0.027, P = 0.007, P = 0.023, P = 0.008). In multivariate regression analysis, the same factors did not affect rejection.
CONCLUSION The serum 25 (OH) vitamin D level in kidney transplant recipients remained low. Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis, this finding was not confirmed by multivariate analysis. Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.
Collapse
Affiliation(s)
- Semih Buyukdemirci
- Department of Internal Medicine, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| | - Sanem Guler Cimen
- Department of General Surgery, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| | - Hatice Sahin
- Department of Nephrology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| | - Sertac Cimen
- Department of Urology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
| |
Collapse
|
5
|
Verma P, Shrivastava A, Siddiqui SA, Yadav RK, Singh MV, Tripathi A, Maurya M, Mishra N. Effect of Vitamin D Supplementation on CD4 Count in HIV-Infected Children and Adolescents in North India: A Non-Randomized Comparative Study. J Trop Pediatr 2022; 68:6659044. [PMID: 35944184 DOI: 10.1093/tropej/fmac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND HIV infection is still a serious public health issue globally. Suboptimal vitamin D status is highly prevalent in HIV-infected children and adolescents throughout the world. OBJECTIVES To evaluate the outcome of vitamin D supplementation on CD4 count in HIV-infected children and adolescents with suboptimal vitamin D status. METHODS Vitamin D level of HIV-infected children and adolescents were measured at enrolment. Suboptimal vitamin D level was defined as 25(OH)D < 30 ng/ml. Vitamin D insufficiency and deficiency were defined as 21-29 and <20 ng/ml, respectively. Children with suboptimal vitamin D levels were supplemented with vitamin D. RESULTS This was a single-centre, non-randomized comparative study enrolling 50 eligible participants. There were 20 patients who were vitamin D sufficient, 7 were vitamin D insufficient and 23 were found to be vitamin D deficient at enrolment. However, after supplementation, the status of sufficient remained same and 7 insufficient become sufficient, whereas in 23 deficient, 18 (78.3%) become sufficient and 5 (21.7%) become insufficient and this change was found statistically significant among the groups (χ2 = 6.52, p = 0.038). There was a significant improvement of CD4 count from baseline to 4 months in deficient group on vitamin D supplementation (p value < 0.001; 1.2-fold rise). No significant change was seen in vitamin D insufficient (p value = 0.791) and sufficient groups (p value = 0.168). CONCLUSION Vitamin D should be supplemented in HIV-infected children on ART with low CD4 counts.
Collapse
Affiliation(s)
- Prabha Verma
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Anubha Shrivastava
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Shahid Akhtar Siddiqui
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Rajesh Kumar Yadav
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Mukesh Vir Singh
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Ambuj Tripathi
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Manisha Maurya
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Nandita Mishra
- Department of Pediatrics, S.N. Children Hospital, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| |
Collapse
|
6
|
Muhihi A, Fawzi WW, Aboud S, Nagu TJ, Ulenga N, Wang M, Mugusi F, Sudfeld CR. Cholecalciferol Supplementation Does Not Affect the Risk of HIV Progression, Viral Suppression, Comorbidities, Weight Loss, and Depression among Tanzanian Adults Initiating Antiretroviral Therapy: Secondary Outcomes of a Randomized Trial. J Nutr 2022; 152:1983-1990. [PMID: 35460249 PMCID: PMC9361733 DOI: 10.1093/jn/nxac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies suggest that blood concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with morbidity, viral suppression, and mortality among adults living with HIV. OBJECTIVES We evaluated the effect of cholecalciferol (vitamin D3) supplementation on the risk of HIV disease progression, HIV-1 viral suppression, comorbidities, weight change, and depression among HIV-infected individuals that were initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. METHODS We conducted a randomized, double-blind, placebo-controlled trial of vitamin D3 supplementation among 4000 HIV-infected adult men and nonpregnant women initiating ART with insufficient serum 25(OH)D concentrations (<30 ng/mL). Participants were randomly assigned to receive either weekly 50,000-IU doses for 4 wk followed by daily 2000 IU vitamin D3 until 1 y or a matching placebo regimen given in weekly followed by daily doses until 1 y. Participants were followed up at weekly visits for the first month followed by monthly visits thereafter. We conducted intent-to-treat analyses to assess the effect of vitamin D3 supplementation on the secondary trial outcomes of HIV progression or death, viral suppression, comorbidities, change in BMI, >10% weight loss, incident wasting, and depression. RESULTS During follow-up, 345 participants (17.2%) in the vitamin D3 group and 371 participants (18.6%) in the placebo group experienced HIV disease progression or death and there was no difference in risk between groups (RR: 0.91; 95% CI: 0.79, 1.06). Vitamin D3 supplementation did not affect the risk of an unsuppressed HIV-1 viral load (>1000 copies/mL) after 6 mo (RR: 1.10; 95% CI: 0.87, 1.41) and there was also no effect on change in BMI, risk of >10% weight loss, wasting, comorbidities, and depression (P values >0.05). CONCLUSIONS Vitamin D supplementation did not affect the risk of HIV progression, viral suppression, common morbidities, weight-related indicators, or depression among adults initiating ART in Tanzania.This trial was registered at clinicaltrials.gov as NCT01798680.
Collapse
Affiliation(s)
- Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini J Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | |
Collapse
|
7
|
Sudfeld CR, Manji KP, Muhihi A, Duggan CP, Aboud S, Alwy Al-Beity FM, Wang M, Zhang N, Ulenga N, Fawzi WW. Vitamin D3 supplementation during pregnancy and lactation for women living with HIV in Tanzania: A randomized controlled trial. PLoS Med 2022; 19:e1003973. [PMID: 35427363 PMCID: PMC9012360 DOI: 10.1371/journal.pmed.1003973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Observational studies suggest that vitamin D deficiency among people living with HIV is associated with a greater risk of disease progression and death. Low levels of vitamin D in pregnancy are also associated with poor fetal and infant growth. Therefore, vitamin D supplementation may improve clinical outcomes for pregnant women living with HIV and improve fetal and postnatal growth for their infants. METHODS AND FINDINGS We conducted a randomized, triple-blind, placebo-controlled trial of vitamin D3 supplementation among pregnant and lactating women living with HIV in Dar es Salaam, Tanzania (ClinicalTrials.gov NCT02305927). Participants were randomized with 1:1 allocation stratified by study clinic to receive either daily 3,000 IU vitamin D3 supplements or matching placebo supplements from the second trimester of pregnancy (12-27 weeks) until 1 year postpartum. The primary outcomes were (i) maternal HIV progression or death, (ii) small-for-gestational-age (SGA) live births (<10th percentile), and (iii) infant stunting at 1 year of age (length-for-age z-score < -2). We also examined the effect of vitamin D3 supplementation on secondary maternal and infant health outcomes, maternal and infant serum 25-hydroxyvitamin D (25[OH]D) concentrations, and maternal hypercalcemia. An intent-to-treat analysis was used as the primary analytic approach. We enrolled 2,300 pregnant women between June 15, 2015, and April 17, 2018, and follow-up of mothers and infants was completed on October 20, 2019. There were 1,148 pregnant women randomly assigned to the vitamin D3 group, and 1,152 to the placebo group. The proportion of mothers lost to follow-up at 1 year postpartum was 6.6% in the vitamin D3 group (83 of 1,148) and 6.6% in the placebo group (76 of 1,152). The proportion of children lost to follow-up at 1 year of age was 5.5% in the vitamin D3 group (59 of 1,074 live births) and 5.2% in the placebo group (57 of 1,093 live births). There was no difference in the risk of maternal HIV progression or death, with 166 events during 1,461 person-years of follow-up in the vitamin D3 group and 141 events during 1,469 person-years of follow-up in the placebo group (hazard ratio 1.21, 95% CI 0.97 to 1.52, p = 0.09). There was no difference in the risk of SGA birth between the vitamin D3 (229 SGA births among 1,070 live births) and placebo groups (236 SGA births among 1,091 live births) (relative risk 1.03, 95% CI 0.87 to 1.22, p = 0.70). There was also no difference in the risk of infant stunting at 1 year of age between the vitamin D3 (407 events among 867 infants) and placebo groups (413 events among 873 infants) (relative risk 1.00, 95% CI 0.92 to 1.10, p = 0.95). In terms of adverse events, no cases of maternal hypercalcemia were identified. One hypersensitivity reaction to the trial supplements occurred for a pregnant woman in the placebo group. A limitation of our study is that our findings may not be generalizable to HIV-negative pregnant women or contexts where severe vitamin D deficiency is prevalent. CONCLUSIONS The trial findings do not support routine vitamin D supplementation for pregnant and lactating women living with HIV in Tanzania. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02305927.
Collapse
Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Karim P. Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher P. Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fadhlun M. Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ning Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
8
|
Buonsenso D, Pata D, Turriziani Colonna A, Ferrari V, Salerno G, Valentini P. Vitamin D and tuberculosis in children: a role in the prevention or treatment of the disease? Monaldi Arch Chest Dis 2022; 92. [PMID: 35352542 DOI: 10.4081/monaldi.2022.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the growing number of published studies, the role of vitamin D in the prevention or treatment of tuberculosis remains unclear. In this review we analyze current scientific literature to provide evidence about the relationship between vitamin D and TB, with a special focus on the pediatric population. While in vitro studies have shown relevant antimycobacterial immune-stimulatory and immunosuppressive effects of vitamin D, this has not panned out in vivo with active TB. On the contrary, there is some evidence that this tool could work as prevention - both against TB infection as well as progression from latent to active infection. However, only a few studies have evaluated this correlation in children. The potential link between tuberculosis and vitamin D levels is promising. If effective, vitamin D supplementation of at-risk populations would be an affordable public health intervention, particularly in light of the worldwide increase in identified TB cases and drug-resistance. Vitamin D might represent a new, affordable, safe and easy to access drug for the prevention and treatment of TB. For stronger evidence, considering the features of infection (relative low incidence of reactivation of latent infection in immunocompetent patients) we need clinical trials with large numbers of participants conducted in endemic regions with a prolonged follow-up time.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome.
| | - Davide Pata
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | | | - Vittoria Ferrari
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Gilda Salerno
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome; Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| |
Collapse
|
9
|
Piloya TW, Bakeera–Kitaka S, Kisitu GP, Idro R, Cusick SE. Vitamin D status and associated factors among HIV-infected children and adolescents on antiretroviral therapy in Kampala, Uganda. PLoS One 2021; 16:e0253689. [PMID: 34166428 PMCID: PMC8224887 DOI: 10.1371/journal.pone.0253689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 06/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background A high prevalence of suboptimal serum vitamin D has been reported among HIV infected children even in countries with high sunshine abundance throughout the year. Vitamin D is a potent immune modulator of innate and adaptive immune responses. Vitamin D regulates immune responses through the vitamin D receptor on CD4 cells. We aimed to determine the vitamin D status of HIV infected children and factors associated with suboptimal vitamin D. Methods This was a cross sectional study. We enrolled children aged between 6 months and 12 years attending an outpatient paediatric HIV clinic. Serum 25-hydroxyvitamin D (25(OH)D) was measured using the electrochemoluminisence method. Suboptimal vitamin D was defined as 25(OH)D <30 ng/ml, vitamin D insufficiency and deficiency were 21–29 ng/ml and <20 ng/ml respectively. Anthropometry, physical exam and medical history were documented. Logistic regression was performed. Results We enrolled 376 children with mean age (sd) 8.05 years (3.03), a median (IQR) duration of ART of 5.9 years (3.2–8.4). Majority of the children (64%) had been exposed to non nucleoside reverse transcriptase inhibitors (NNRTIs). A third were severely immunosuppressed (CD4% ≤15%) at ART initiation. At the time of the study, the majority (89%) were virologically suppressed (VL <1000 copies/ml). Prevalence of 25(OH)D <30 ng/ml was 49 (13%) of 375 participants and 11 (3%) had 25(OH)D <20 ng/ml. Lopinavir/ritonavir regimen was independently associated with 25(OH)D <30 ng/ml; OR 0.27 CI (0.13–0.57), p value-0.002. Serum 25(OH)D <20 ng/ml was associated with CD4 count ≤15% at ART initiation OR 6.55(1.30–32.9), p value—0.023 and use of NNRTIs; OR 10.9(1.22–96.2), p value—0.03. Conclusion We found a low prevalence of suboptimal vitamin D compared to earlier reports. Severe immunosuppression at ART initiation and use of NNRTIs increases odds of deficiency. Vitamin D supplementation should be considered in severely immunosuppressed children initiating ART.
Collapse
Affiliation(s)
- Thereza Were Piloya
- Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Sabrina Bakeera–Kitaka
- Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Paul Kisitu
- Baylor College of Medicine, Paediatric Centre of Excellence, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| |
Collapse
|
10
|
Crutchley RD, Jacobs DM, Gathe J, Mayberry C, Bulayeva N, Rosenblatt KP, Garey KW. Vitamin D Assessment Over 48 Weeks in Treatment-Naive HIV Individuals Starting Lopinavir/Ritonavir Monotherapy. Curr HIV Res 2021; 19:61-72. [PMID: 32860360 DOI: 10.2174/1570162x18666200827115615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitamin D deficiency is common in HIV population and has been associated with increased comorbidity risk and poor immunologic status. OBJECTIVE To evaluate the effect of protease inhibitor lopinavir/ritonavir monotherapy on changes in serum 25-hydroxyvitamin D [25(OH)D] over 48 weeks. METHODS Thirty-four treatment-naïve HIV individuals initiating lopinavir/ritonavir monotherapy and receiving clinical care from private practice in Houston, Texas, were included. Serum 25-hydroxyvitamin D levels from stored plasma samples collected from IMANI-2 pilot study at both baseline and 48 weeks were analyzed using LC-MS assays. Mean 25(OH)D at baseline and 48 weeks were compared using paired t-tests. Linear regression analysis was used to evaluate factors associated with changes in 25(OH)D. Logistic regression analyses were used to determine the effect of vitamin D status and covariates on CD4 cell count recovery. RESULTS Mean 25(OH)D was significantly higher at 48 weeks (26.3 ng/mL (SD + 14.9); p=0.0003) compared to baseline (19.8 ng/mL (SD +12.1), with fewer individuals having vitamin D deficiency (41.2%) and severe deficiency (11.8%). Both body mass index and baseline CD4 cell count were significant independent covariates associated with 25(OH)D changes over 48 weeks. Baseline vitamin D status did not affect CD4 cell count recovery. However, in a 24-week multivariate analysis, current tobacco use was significantly associated with a decreased odds of CD4 cell count recovery (AOR 0.106, 95% CI 0.018-0.606; p=0.012). CONCLUSION Individuals treated with lopinavir/ritonavir monotherapy had significantly higher 25(OH)D after 48 weeks. Current tobacco users had significantly diminished CD4 cell count recovery after starting treatment, warranting further clinical investigation.
Collapse
Affiliation(s)
- Rustin D Crutchley
- Department of Pharmacotherapy, Washington State University, College of Pharmacy and Pharmaceutical Sciences, Yakima, WA, United States
| | - David M Jacobs
- Department of Pharmacy Practice, University at Buffalo, The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, United States
| | - Joseph Gathe
- Therapeutic Concepts, Inc, Houston, TX, United States
| | - Carl Mayberry
- Therapeutic Concepts, Inc, Houston, TX, United States
| | - Nataliya Bulayeva
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kevin P Rosenblatt
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Houston, TX, United States
| |
Collapse
|
11
|
Sudfeld CR, Mugusi F, Muhihi A, Aboud S, Nagu TJ, Ulenga N, Hong B, Wang M, Fawzi WW. Efficacy of vitamin D 3 supplementation for the prevention of pulmonary tuberculosis and mortality in HIV: a randomised, double-blind, placebo-controlled trial. Lancet HIV 2020; 7:e463-e471. [PMID: 32621874 DOI: 10.1016/s2352-3018(20)30108-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Observational data suggest that low vitamin D status is associated with an increased incidence of pulmonary tuberculosis and mortality among people living with HIV. The primary aims of this study were to assess the effect of vitamin D3 supplementation on the risk of mortality and incidence of pulmonary tuberculosis among adults initiating antiretroviral therapy (ART). METHODS This was a randomised, double-blind, placebo-controlled trial of vitamin D3 supplementation among adults living with HIV who initiated ART and had serum 25-hydroxyvitamin D concentrations of less than 30 ng/mL at four large HIV care and treatment centres in Dar es Salaam, Tanzania. Patients were excluded if they were younger than 18 years, pregnant at the time of randomisation, or were enrolled in any other clinical trial. Patients were randomly assigned 1:1 to receive either weekly oral 50 000 IU vitamin D3 supplements (cholecalciferol) for the first month of ART followed by daily 2000 IU vitamin D3 supplements or a matching weekly and daily placebo regimen. The randomisation list was computer-generated by a non-study statistician with sequence blocks of ten that were stratified by study clinic. Complete allocation concealment was ensured and patients, field team, and investigators were masked to group assignment. The trial follow-up duration was 1 year and the primary efficacy outcomes were death and incident pulmonary tuberculosis. An intention-to-treat analysis was followed for all-cause mortality; participants diagnosed with or receiving treatment for pulmonary tuberculosis at randomisation, or suspected to have tuberculosis at randomisation and who later had that diagnosis confirmed, were excluded from analyses of pulmonary tuberculosis incidence. Safety was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT01798680, and is completed. FINDINGS Between Feb 24, 2014, and Feb 24, 2017, 6250 adults initiating ART had serum 25-hydroxyvitamin D screening, 4000 of whom were enrolled in the trial and followed up for 1 year (follow-up of all participants was completed on March 7, 2018). 2001 patients were randomly assigned to the vitamin D3 supplementation group, and 1999 to the placebo group. 415 deaths were recorded: 211 in the vitamin D3 group and 204 in the placebo group. Among all randomly assigned participants, there was no overall effect of vitamin D3 supplementation on the risk of mortality (hazard ratio [HR] 1·04, 95% CI 0·85-1·25; p=0·73). There was also no difference in the overall incidence of pulmonary tuberculosis between the vitamin D3 (50 events in 1812 patients analysed) and placebo groups (64 events in 1827 patients; HR 0·78, 0·54-1·13; p=0·19). The vitamin D3 regimen did not increase the risk of hypercalcaemia (three events in the vitamin D3 group and two events in the placebo group; relative risk 1·25, 95% CI 0·43-3·66; Fisher's exact p=1·00). 101 hospital admissions were reported in the vitamin D3 group and 94 in the placebo group (incidence rate ratio 1·06, 95% CI 0·80-1·41; p=0·66). INTERPRETATION Additional research is needed before vitamin D3 supplementation should be considered for implementation in HIV care and treatment programmes for the prevention of pulmonary tuberculosis or mortality. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
Collapse
Affiliation(s)
- Christopher R Sudfeld
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini J Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Biling Hong
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
12
|
Lee S, Lee JE, Lee SO, Sim YK, Lee SH. Influence of Vitamin D Deficiency on the Development of Opportunistic Infection in People Living with HIV/AIDS (PWHAs). J Am Coll Nutr 2020; 40:545-550. [DOI: 10.1080/07315724.2020.1805043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soon Ok Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong Ki Sim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
13
|
Noor RA, Abioye AI, Hertzmark E, Darling AM, Aboud S, Mugusi FM, Sudfeld CR, Spiegelman D, Fawzi WW. Impaired Hematological Status Increases the Risk of Mortality among HIV-Infected Adults Initiating Antiretroviral Therapy in Tanzania. J Nutr 2020; 150:2375-2382. [PMID: 32621487 PMCID: PMC7540061 DOI: 10.1093/jn/nxaa172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/06/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hematological status may predict HIV disease progression and mortality among adults initiating highly active antiretroviral therapy (HAART). OBJECTIVES We aimed to examine the relation of anemia and iron status at HAART initiation with survival and morbidity outcomes. METHODS We conducted a case-cohort study of 570 HIV-infected adults initiating HAART who were enrolled in a trial of multivitamins in Tanzania. Hemoglobin, serum ferritin, and hepcidin concentrations were assessed at HAART initiation and participants were followed up monthly. We adjusted serum ferritin for inflammation using a regression correction method to characterize hematological status. Cox proportional hazards models were used to estimate HRs for mortality and incident clinical outcomes. RESULTS We found an 83% prevalence of anemia, 15% prevalence of iron deficiency anemia, and 66% prevalence of anemia of chronic diseases (ACD). The prevalence of elevated iron was 33% and 19% had iron deficiency (ID). After multivariate adjustment, severe anemia (HR: 2.57; 95% CI: 1.49, 4.45) and ACD (HR: 4.71; 95% CI: 2.91, 7.62) were associated with increased risk of mortality as compared with nonanemic participants. In addition, both ID (HR: 2.65; 95% CI: 1.08, 7.78) and elevated iron (HR: 2.83; 95% CI: 2.10, 3.82) were associated with increased risk of mortality as compared with normal iron concentrations. Severe anemia and elevated iron concentrations were associated with incident wasting and >10% weight loss (P values <0.05). CONCLUSIONS Anemia and both ID and elevated iron were associated with increased mortality among HIV-infected adults initiating HAART. Safety and efficacy studies including anemia etiology, timing of HAART initiation, and dose of iron supplementation among HIV patients appear warranted.This trial was registered at clinicaltrials.gov as NCT00383669.
Collapse
Affiliation(s)
| | - Ajibola I Abioye
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anne M Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Donna Spiegelman
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
14
|
Reuter A, Furin J. The problem with vitamin D supplementation for tuberculosis. Lancet HIV 2020; 7:e450-e451. [PMID: 32621871 DOI: 10.1016/s2352-3018(20)30114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - Jennifer Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA 02115, USA.
| |
Collapse
|
15
|
Chokuda E, Reynolds C, Das S. Association of Low Vitamin D with Complications of HIV and AIDS: A literature Review. Infect Disord Drug Targets 2020; 20:122-142. [PMID: 30574856 DOI: 10.2174/1871526519666181221122731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
With the advent of combination antiretroviral therapy (cART), the survival of HIV patients has improved dramatically, but the complications of the disease and treatment have become an important issue in the management of HIV patients. Vitamin-D deficiency is common in HIV patients. Low vitamin-D is associated with different comorbidities in the HIV uninfected general population. In this review, we first briefly describe vitamin D synthesis and mechanism of action and we focus on the epidemiological and clinical data dealing with the relationship between vitamin D deficiency in HIV infection with several comorbidities which has been found to be increasingly common in patients living with HIV infection. We searched the PubMed database using the keywords "HIV," "vitamin D" and other common disorders or conditions that are relatively common in HIV infection. The other conditions included in the search were osteoporosis and fracture, cardiovascular disease, diabetes and insulin resistance, active tuberculosis, hepatitis-C co-infection, and HIV disease progression. Articles presenting original data as well as systematic reviews and met analysis related to HIV population were included in our analysis. Vitamin-D deficiency seems to be associated with several adverse outcomes in HIV patients but a definite cause and effect relationship with vitamin-D is yet to be confirmed in most of the cases. However, the literature supporting the efficacy of vitamin-D supplementation is lacking.
Collapse
Affiliation(s)
- Evelyn Chokuda
- Department of HIV Medicine, Coventry & Warwickshire Partnership Trust, Coventry, United Kingdom
| | - Chris Reynolds
- Department of HIV Medicine, Coventry & Warwickshire Partnership Trust, Coventry, United Kingdom
| | - Satyajit Das
- Department of HIV Medicine, Coventry & Warwickshire Partnership Trust, Coventry, United Kingdom
| |
Collapse
|
16
|
Aibana O, Huang CC, Aboud S, Arnedo-Pena A, Becerra MC, Bellido-Blasco JB, Bhosale R, Calderon R, Chiang S, Contreras C, Davaasambuu G, Fawzi WW, Franke MF, Galea JT, Garcia-Ferrer D, Gil-Fortuño M, Gomila-Sard B, Gupta A, Gupte N, Hussain R, Iborra-Millet J, Iqbal NT, Juan-Cerdán JV, Kinikar A, Lecca L, Mave V, Meseguer-Ferrer N, Montepiedra G, Mugusi FM, Owolabi OA, Parsonnet J, Roach-Poblete F, Romeu-García MA, Spector SA, Sudfeld CR, Tenforde MW, Togun TO, Yataco R, Zhang Z, Murray MB. Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis. PLoS Med 2019; 16:e1002907. [PMID: 31509529 PMCID: PMC6738590 DOI: 10.1371/journal.pmed.1002907] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk. METHODS AND FINDINGS We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. For each case, we randomly selected four controls from among contacts who did not develop TB disease, matching on gender and year of age. We also conducted a one-stage individual-participant data (IPD) meta-analysis searching PubMed and Embase to identify prospective studies of vitamin D and TB disease until June 8, 2019. We included studies that assessed vitamin D before TB diagnosis. In the primary analysis, we defined vitamin D deficiency as 25-(OH)D < 50 nmol/L, insufficiency as 50-75 nmol/L, and sufficiency as >75nmol/L. We estimated the association between baseline vitamin D status and incident TB using conditional logistic regression in the Lima cohort and generalized linear mixed models in the meta-analysis. We further defined severe vitamin D deficiency as 25-(OH)D < 25 nmol/L and performed stratified analyses by HIV status in the IPD meta-analysis. In the Lima cohort, we analyzed 180 cases and 709 matched controls. The adjusted odds ratio (aOR) for TB risk among participants with baseline vitamin D deficiency compared to sufficient vitamin D was 1.63 (95% CI 0.75-3.52; p = 0.22). We included seven published studies in the meta-analysis and analyzed 3,544 participants. In the pooled analysis, the aOR was 1.48 (95% CI 1.04-2.10; p = 0.03). The aOR for severe vitamin D deficiency was 2.05 (95% CI 0.87-4.87; p trend for decreasing 25-(OH)D levels from sufficient vitamin D to severe deficiency = 0.02). Among 1,576 HIV-positive patients, vitamin D deficiency conferred a 2-fold (aOR 2.18, 95% CI 1.22-3.90; p = 0.01) increased risk of TB, and the aOR for severe vitamin D deficiency compared to sufficient vitamin D was 4.28 (95% CI 0.85-21.45; p = 0.08). Our Lima cohort study is limited by the short duration of follow-up, and the IPD meta-analysis is limited by the number of possible confounding covariates available across all studies. CONCLUSION Our findings suggest vitamin D predicts TB disease risk in a dose-dependent manner and that the risk of TB disease is highest among HIV-positive individuals with severe vitamin D deficiency. Randomized control trials are needed to evaluate the possible role of vitamin D supplementation on reducing TB disease risk.
Collapse
Affiliation(s)
- Omowunmi Aibana
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, United States of America
| | - Chuan-Chin Huang
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam, Tanzania
| | | | - Mercedes C. Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Ramesh Bhosale
- Department of Obstetrics & Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Silvia Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | - Ganmaa Davaasambuu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jerome T. Galea
- School of Social Work, University of South Florida, Tampa, Florida, United States of America
| | | | | | | | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University CRS, Pune, India
| | - Rabia Hussain
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
| | | | - Najeeha T. Iqbal
- Department of Pediatrics and Child Health and Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Aarti Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Leonid Lecca
- Partners in Health—Socios En Salud Sucursal, Lima, Peru
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University CRS, Pune, India
| | | | - Grace Montepiedra
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ferdinand M. Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam, Tanzania
| | - Olumuyiwa A. Owolabi
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Julie Parsonnet
- Departments of Medicine and of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Stephen A. Spector
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, La Jolla, California, United States of America
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mark W. Tenforde
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Toyin O. Togun
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Rosa Yataco
- Partners in Health—Socios En Salud Sucursal, Lima, Peru
| | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
17
|
Choi YJ, Lim YH, Lee KS, Hong YC. Elevation of ambient temperature is associated with an increased risk of herpes zoster: a time-series analysis. Sci Rep 2019; 9:12254. [PMID: 31439885 PMCID: PMC6706431 DOI: 10.1038/s41598-019-48673-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Although varicella zoster (VZ) and herpes zoster (HZ) are caused by the same varicella zoster virus (VZV), the former is caused by primary infection while the latter is caused by reactivation of latent VZV, and their relationships with ambient temperature are also different. It is relatively well-established that VZ incidence declines with ambient temperature, but the relationship between HZ and ambient temperature is inconclusive. Thus, we investigated the effects of ambient temperature on the incidence of HZ in time-series analysis by using data from the Korean National Emergency Department Information System between 2014 and 2016. We applied a generalized linear model to investigate the relationship between ambient temperature and emergency room (ER) visits due to HZ, after controlling for confounders in seven metropolitan cities and nine provinces in South Korea. Region-specific estimates were pooled to obtain the national average estimates. There were a total of 61,957 ER visits nationwide for HZ during the study period. HZ significantly increased by 2.03% to 2.94% in the moving average lag models throughout 0 to 11 days with maximum percent increase of 2.94% (95% CI: 2.20, 3.68) in the 6-day moving average lag model.
Collapse
Affiliation(s)
- Yoon-Jung Choi
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea. .,Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyung-Shin Lee
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Vitamin D (VitD) deficiency is highly prevalent among HIV-infected individuals. Given the overlapping risk for several chronic disease and immunomodulatory outcomes from both long-standing HIV and VitD deficiency, there is great interest in clarifying the clinical role of VitD for this population. RECENT FINDINGS Recent studies have expanded our knowledge regarding the epidemiology and mechanisms of VitD deficiency-associated outcomes in the setting of HIV. Clinical trials focusing on VitD supplementation have demonstrated a positive impact on bone mineral density in subgroups of HIV-infected individuals initiating ART or on suppressive ART regimens; however, significant heterogeneity exists between studies and data are less consistent with other clinical outcomes. Further research is needed to clarify uncertainly in several domains, including identifying patients at greatest risk for poor outcomes from VitD deficiency, standardizing definitions and measurement techniques, and better quantifying the benefits and risks of VitD supplementation across different demographic strata for skeletal and extra-skeletal outcomes.
Collapse
Affiliation(s)
- Evelyn Hsieh
- Section of Rheumatology, Yale School of Medicine, 300 Cedar Street, TAC S-525, PO Box 208031, New Haven, CT, 06517, USA.
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
19
|
Bivona G, Agnello L, Lo Sasso B, Scazzone C, Butera D, Gambino CM, Iacolino G, Bellia C, Ciaccio M. Vitamin D in malaria: more hypotheses than clues. Heliyon 2019; 5:e01183. [PMID: 30793054 PMCID: PMC6370580 DOI: 10.1016/j.heliyon.2019.e01183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 12/15/2022] Open
Abstract
Vitamin D is a secosteroid hormone regulating calcium and phosphate metabolism, immune response and brain development. Low blood 25(OH)D levels have been reported in patients affected by infectious diseases caused by parasites, including malaria. Despite the high effectiveness of antimalarials, malaria is burdened with high morbidity and mortality, and the search for additional therapies is rapidly growing. Furthermore, available preventive measures have proved to be barely effective so far. Finding new prevention and therapy tools is a matter of urgency. Studies on animal models and humans have hypothesized some mechanisms by which the hormone can influence malaria pathogenesis, and the role of Vitamin D supplementation in preventing and treating this disease has been suggested. Few studies on the association between Vitamin D and malaria are available and disagreeing results have been reported. Studies in humans reporting an association between low 25(OH)D circulating levels and Malaria have a small sample size and observational study-set. Randomized controlled trials are needed in order to understand if Vitamin D administration might play a role in preventing and treating malaria.
Collapse
Affiliation(s)
- Giulia Bivona
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Luisa Agnello
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Bruna Lo Sasso
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Concetta Scazzone
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Daniela Butera
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Caterina Maria Gambino
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Giorgia Iacolino
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Chiara Bellia
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
- Department and U.O.C. Laboratory Medicine, University Hospital “Paolo Giaccone” of Palermo, Italy
| |
Collapse
|
20
|
Afzal A, Rathore R, Butt NF, Randhawa FA. Efficacy of Vitamin D supplementation in achieving an early Sputum Conversion in Smear positive Pulmonary Tuberculosis. Pak J Med Sci 2018; 34:849-854. [PMID: 30190740 PMCID: PMC6115594 DOI: 10.12669/pjms.344.14397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To determine the efficacy of Vitamin D supplementation in achieving an early sputum conversion in vitamin D deficient smear positive pulmonary tuberculosis patients. Methods: This randomized clinical trial was done at Mayo hospital Lahore from November 2015 to August 2016. One hundred twenty patients with sputum smear positive pulmonary tuberculosis were selected and randomized to Group-A (taking anti-tuberculous therapy (ATT) only) and Group-B (taking ATT with Vitamin D supplementation). Four doses of100,000 IU of Vitamin D injection intramuscularly were given after every 14 days during intensive-phase. Sputum examination was repeated at 2nd, 4th, 6th, 8th, 10th and 12th weeks. Efficacy of treatment in terms of early sputum conversion between both groups was tested using Chi square and independent sample t-test was applied to compare mean values of serum vitamin D before and after treatment. P-value ≤ 0.05 was considered as significant. Results: The mean age of patients was 37.18±6.81 years in Group-A and 39.02±7.56 years in Group-B. There were 63 (52.50%) males and 57 (47.50%) females. The mean serum Vitamin D was 17.07±1.44 in Group-A and 17.23±2.37 in Group-B at baseline and at 12th week, the levels were 21.77±2.23 in Group-A and 29.24±0.72 in Group-B. In Group-A, 7 (11.7%) patients showed positive sputum examination and in Group-B, only one (1.7%) patient had positive sputum examination at 12th week. The difference was statistically significant (p-value= 0.028). Conclusion: Four doses of intramuscular vitamin D given after every 14 days corrected vitamin D deficiency and improved the rate of sputum smear conversion in patients of pulmonary tuberculosis.
Collapse
Affiliation(s)
- Arbab Afzal
- Arbab Afzal, MD. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Rabia Rathore
- Rabia Rathore, FCPS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Nasir Farooq Butt
- Nasir Farooq But, FCPS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Fawad Ahmad Randhawa
- Fawad Ahmad Randhawa, FCPS. Department of Medicine, Mayo Hospital, Lahore, Pakistan
| |
Collapse
|
21
|
Abhimanyu, Coussens AK. The role of UV radiation and vitamin D in the seasonality and outcomes of infectious disease. Photochem Photobiol Sci 2018; 16:314-338. [PMID: 28078341 DOI: 10.1039/c6pp00355a] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The seasonality of infectious disease outbreaks suggests that environmental conditions have a significant effect on disease risk. One of the major environmental factors that can affect this is solar radiation, primarily acting through ultraviolet radiation (UVR), and its subsequent control of vitamin D production. Here we show how UVR and vitamin D, which are modified by latitude and season, can affect host and pathogen fitness and relate them to the outcomes of bacterial, viral and vector-borne infections. We conducted a thorough comparison of the molecular and cellular mechanisms of action of UVR and vitamin D on pathogen fitness and host immunity and related these to the effects observed in animal models and clinical trials to understand their independent and complementary effects on infectious disease outcome. UVR and vitamin D share common pathways of innate immune activation primarily via antimicrobial peptide production, and adaptive immune suppression. Whilst UVR can induce vitamin D-independent effects in the skin, such as the generation of photoproducts activating interferon signaling, vitamin D has a larger systemic effect due to its autocrine and paracrine modulation of cellular responses in a range of tissues. However, the seasonal patterns in infectious disease prevalence are not solely driven by variation in UVR and vitamin D levels across latitudes. Vector-borne pathogens show a strong seasonality of infection correlated to climatic conditions favoring their replication. Conversely, pathogens, such as influenza A virus, Mycobacterium tuberculosis and human immunodeficiency virus type 1, have strong evidence to support their interaction with vitamin D. Thus, UVR has both vitamin D-dependent and independent effects on infectious diseases; these effects vary depending on the pathogen of interest and the effects can be complementary or antagonistic.
Collapse
Affiliation(s)
- Abhimanyu
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa.
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa. and Division of Medical Microbiology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa
| |
Collapse
|
22
|
Dragonas P, Kaste LM, Nunn M, Gajendrareddy PK, Weber KM, Cohen M, Adeyemi OM, French AL, Sroussi HY. Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS). Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:567-573. [PMID: 29550079 PMCID: PMC6002805 DOI: 10.1016/j.oooo.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to test a hypothesized positive association between low vitamin D (VitD) serum levels and the severity of periodontal disease in women with HIV infection. STUDY DESIGN This was a cross-sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss (CAL) measurements were available for 74 women with HIV infection. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by obtaining the averages of measurements taken at 4 sites in each measured tooth. RESULTS Average age of study participants (n = 74) was 39.6 years (standard deviation 7.2), and the majority were African Americans (70.3%) with VitD deficiency (58.1%). VitD deficiency was positively associated with higher mCAL (P = .012). After adjustment for race, age, smoking, and HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438; P = .036). CONCLUSIONS We identified a previously unreported association between VitD deficiency and mCAL in women with HIV infection. Larger and more inclusive, multisite, longitudinal studies are warranted to investigate whether these findings can be generalized to all individuals with HIV infection in the current treatment era and to determine causality.
Collapse
Affiliation(s)
- Panagiotis Dragonas
- Department of Periodontology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Linda M Kaste
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Martha Nunn
- Department of Periodontics, School of Dentistry, Creighton University, Omaha, NE, USA
| | - Praveen K Gajendrareddy
- Department of Periodontology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen M Weber
- The Core Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge Cohen
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Oluwatoyin M Adeyemi
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Audrey L French
- The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL, USA
| | - Herve Y Sroussi
- Division of Oral Medicine & Dentistry, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
23
|
Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study. J Acquir Immune Defic Syndr 2017; 75:e71-e79. [PMID: 28169875 DOI: 10.1097/qai.0000000000001308] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Numerous micronutrients have immunomodulatory roles that may influence risk of tuberculosis (TB), but the association between baseline micronutrient deficiencies and incident TB after antiretroviral therapy (ART) initiation in HIV-infected individuals is not well characterized. METHODS We conducted a case-cohort study (n = 332) within a randomized trial comparing 3 ART regimens in 1571 HIV treatment-naive adults from 9 countries. A subcohort of 30 patients was randomly selected from each country (n = 270). Cases (n = 77; main cohort = 62, random subcohort = 15) included patients diagnosed with TB by 96 weeks post-ART initiation. We determined pretreatment concentrations of vitamin A, carotenoids, vitamin B6, vitamin B12, vitamin D, vitamin E, and selenium. We measured associations between pretreatment micronutrient deficiencies and incident TB using Breslow-weighted Cox regression models. RESULTS Median pretreatment CD4 T-cell count was 170 cells/mm; 47.3% were women; and 53.6% Black. In multivariable models after adjusting for age, sex, country, treatment arm, previous TB, baseline CD4 count, HIV viral load, body mass index, and C-reactive protein, pretreatment deficiency in vitamin A (adjusted hazard ratio, aHR 5.33, 95% confidence interval, CI: 1.54 to 18.43) and vitamin D (aHR 3.66, 95% CI: 1.16 to 11.51) were associated with TB post-ART. CONCLUSIONS In a diverse cohort of HIV-infected adults from predominantly low- and middle-income countries, deficiencies in vitamin A and vitamin D at ART initiation were independently associated with increased risk of incident TB in the ensuing 96 weeks. Vitamin A and D may be important modifiable risk factors for TB in high-risk HIV-infected patients starting ART in resource-limited highly-TB-endemic settings.
Collapse
|
24
|
Aibana O, Franke MF, Huang CC, Galea JT, Calderon R, Zhang Z, Becerra MC, Smith ER, Ronnenberg AG, Contreras C, Yataco R, Lecca L, Murray MB. Impact of Vitamin A and Carotenoids on the Risk of Tuberculosis Progression. Clin Infect Dis 2017; 65:900-909. [PMID: 28531276 PMCID: PMC5848231 DOI: 10.1093/cid/cix476] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/18/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Low and deficient levels of vitamin A are common in low- and middle-income countries where tuberculosis burden is high. We assessed the impact of baseline levels of vitamin A and carotenoids on tuberculosis disease risk. METHODS We conducted a case-control study nested within a longitudinal cohort of household contacts (HHCs) of pulmonary tuberculosis case patients in Lima, Peru. We defined case patients as human immunodeficiency virus (HIV)-negative HHCs with blood samples in whom tuberculosis disease developed ≥15 days after enrollment of the index patient. For each case patient, we randomly selected 4 controls from among contacts in whom tuberculosis disease did not develop, matching for sex and year of age. We used conditional logistic regression to estimate odds ratios for incident tuberculosis disease by vitamin A and carotenoids levels, controlling for other nutritional and socioeconomic factors. RESULTS Among 6751 HIV-negative HHCs with baseline blood samples, 192 had secondary tuberculosis disease during follow-up. We analyzed 180 case patients with viable samples and 709 matched controls. After controlling for possible confounders, we found that baseline vitamin A deficiency was associated with a 10-fold increase in risk of tuberculosis disease among HHCs (adjusted odds ratio, 10.53; 95% confidence interval, 3.73-29.70; P < .001). This association was dose dependent, with stepwise increases in tuberculosis disease risk with each decreasing quartile of vitamin A level. CONCLUSIONS Vitamin A deficiency strongly predicted the risk of incident tuberculosis disease among HHCs of patients with tuberculosis. Vitamin A supplementation among individuals at high risk of tuberculosis may provide an effective means of preventing tuberculosis disease.
Collapse
Affiliation(s)
- Omowunmi Aibana
- Division of General Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School and
| | - Chuan-Chin Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School and
- Partners In Health, Socios En Salud Sucursal Peru, Lima
| | | | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School and
| | - Emily R Smith
- Department of Global Health and Population, Harvard University T. H. Chan School of Public Health, and
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, and
| | | | | | - Rosa Yataco
- Partners In Health, Socios En Salud Sucursal Peru, Lima
| | - Leonid Lecca
- Partners In Health, Socios En Salud Sucursal Peru, Lima
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School and
| |
Collapse
|
25
|
Sudfeld CR, Manji KP, Duggan CP, Aboud S, Muhihi A, Sando DM, Al-beity FMA, Wang M, Fawzi WW. Effect of maternal vitamin D 3 supplementation on maternal health, birth outcomes, and infant growth among HIV-infected Tanzanian pregnant women: study protocol for a randomized controlled trial. Trials 2017; 18:411. [PMID: 28870263 PMCID: PMC5584035 DOI: 10.1186/s13063-017-2157-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitamin D has significant immunomodulatory effects on both adaptive and innate immune responses. Observational studies indicate that adults infected with HIV with low vitamin D status may be at increased risk of mortality, pulmonary tuberculosis, and HIV disease progression. Growing observational evidence also suggests that low vitamin D status in pregnancy may increase the risk of adverse birth and infant health outcomes. As a result, antiretroviral therapy (ART) adjunct vitamin D3 supplementation may improve the health of HIV-infected pregnant women and their children. METHODS/DESIGN The Trial of Vitamins-5 (ToV5) is an individually randomized, double-blind, placebo-controlled trial of maternal vitamin D3 (cholecalciferol) supplementation conducted among 2300 HIV-infected pregnant women receiving triple-drug ART under Option B+ in Dar es Salaam, Tanzania. HIV-infected pregnant women of 12-27 weeks gestation are randomized to either: 1) 3000 IU vitamin D3 taken daily from randomization in pregnancy until trial discharge at 12 months postpartum; or 2) a matching placebo regimen. Maternal participants are followed-up at monthly clinic visits during pregnancy, at delivery, and then with their children at monthly postpartum clinic visits. The primary efficacy outcomes of the trial are: 1) maternal HIV disease progression or death; 2) risk of small-for-gestational age (SGA) births; and 3) risk of infant stunting at 1 year of age. The primary safety outcome of the trial is incident maternal hypercalcemia. Secondary outcomes include a range of clinical and biological maternal and child health outcomes. DISCUSSION The ToV5 will provide causal evidence on the effect of vitamin D3 supplementation on HIV progression and death, SGA births, and infant stunting at 1 year of age. The results of the trial are likely generalizable to HIV-infected pregnant women and their children in similar resource-limited settings utilizing the Option B+ approach. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02305927 . Registered on 29 October 2014.
Collapse
Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
| | - Karim P. Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher P. Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - David M. Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
26
|
Abstract
Vitamin D plays an essential role in the primary therapy and prevention of osteoporosis. Established vitamin D effects are renal and intestinal resorption of calcium and phosphate for optimal bone mineral density; however, the widespread distribution of the vitamin D receptor (VDR), a member of the nuclear steroid hormone receptor family, provides extensive evidence for additional pleiotropic effects of the vitamin D ligand. Vitamin D deficiency and insufficiency are common and were reported as risk factors for a variety of diseases in observational studies. In addition, extensive research from experimental studies also illustrated extraskeletal effects of vitamin D. More randomized controlled trials are ongoing to test the effects of high dose vitamin D supplementation in numerous chronic diseases. This article summarizes the current state of knowledge regarding effects on muscle, on glucose metabolism in type 2 diabetes mellitus and on cardiovascular risk factors and diseases. Furthermore, we discuss the influence of vitamin D on the immune system, whereby vitamin D might provide beneficial effects not only for infectious but also for autoimmune diseases, such as type 1 diabetes mellitus. Current evidence leads to the conclusion that vitamin D deficiency should be avoided in these diseases. Recommendations for optimal dosage are discussed.
Collapse
|
27
|
Kalluri HV, Sacha LM, Ingemi AI, Shullo MA, Johnson HJ, Sood P, Tevar AD, Humar A, Venkataramanan R. Low vitamin D exposure is associated with higher risk of infection in renal transplant recipients. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Hari V. Kalluri
- Department of Pharmaceutical Sciences; University of Pittsburgh; Pittsburgh PA USA
| | - Lauren M. Sacha
- Department of Pharmacy; Saint Barnabas Medical Center; Livingston NJ USA
| | - Amanda I. Ingemi
- Department of Pharmacy; Sentara Norfolk General Hospital; Norfolk VA USA
| | - Michael A. Shullo
- Department of Pharmacy and Therapeutics; University of Pittsburgh; Pittsburgh PA USA
| | - Heather J. Johnson
- Department of Pharmacy and Therapeutics; University of Pittsburgh; Pittsburgh PA USA
| | - Puneet Sood
- Department of Surgery; School of Medicine; University of Pittsburgh; Pittsburgh PA USA
- Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Amit D. Tevar
- Department of Surgery; School of Medicine; University of Pittsburgh; Pittsburgh PA USA
- Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Abhinav Humar
- Department of Surgery; School of Medicine; University of Pittsburgh; Pittsburgh PA USA
- Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences; University of Pittsburgh; Pittsburgh PA USA
- Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
- Department of Pathology; School of Medicine; University of Pittsburgh; Pittsburgh PA USA
| |
Collapse
|
28
|
Sudfeld CR, Mugusi F, Aboud S, Nagu TJ, Wang M, Fawzi WW. Efficacy of vitamin D 3 supplementation in reducing incidence of pulmonary tuberculosis and mortality among HIV-infected Tanzanian adults initiating antiretroviral therapy: study protocol for a randomized controlled trial. Trials 2017; 18:66. [PMID: 28183335 PMCID: PMC5301352 DOI: 10.1186/s13063-017-1819-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/26/2017] [Indexed: 01/31/2023] Open
Abstract
Background HIV-infected adults initiating antiretroviral therapy (ART) in sub-Saharan Africa continue to experience high rates of morbidity and mortality during the initial months of treatment. Observational studies in high-income and resource-limited settings indicate that HIV-infected adults with low vitamin D levels may be at increased risk of mortality, HIV disease progression, and incidence of pulmonary tuberculosis (TB). As a result, vitamin D3 supplementation may improve survival and treatment outcomes for HIV-infected adults initiating ART. Methods/Design The Trial of Vitamins-4 (ToV4) is an individually randomized, double-blind, placebo-controlled trial of vitamin D3 (cholecalciferol) supplementation conducted among 4000 HIV-infected adults with low vitamin D levels [25-hydroxyvitamin D (25(OH)D) <30 ng/mL] initiating ART in Dar es Salaam, Tanzania. The two primary aims of the trial are to determine the effect of a vitamin D3 supplementation regimen on incidence of (1) mortality and (2) pulmonary TB as compared to a matching placebo regimen. The primary safety outcome of the study is incident hypercalcemia. The investigational vitamin D3 regimen consists of oral supplements containing 50,000 IU vitamin D3 taken under direct observation at randomization and once a week for 3 weeks (four doses) followed by daily oral supplements containing 2000 IU vitamin D3 taken at home from the fourth week until trial discharge at 1 year post ART initiation. Trial participants are followed up at weekly clinic visits during the first month of ART and at monthly clinic visits thereafter until trial discharge at 1 year post ART initiation. Secondary aims of the trial are to examine the effect of the vitamin D3 regimen on CD4 T cell reconstitution, incidence of non-TB comorbidities, body mass index (BMI), depression and anxiety, physical activity, bone health, and immunologic biomarkers. Discussion The ToV4 will provide causal evidence on the effect of vitamin D3 supplementation on incidence of pulmonary TB and mortality among HIV-infected Tanzanian adults initiating ART. The trial will also give insight to whether vitamin D3 supplementation trials for the prevention of pulmonary TB should be pursued in HIV-uninfected populations. Trial registration ClinicalTrials.gov, NCT01798680. Registered on 21 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1819-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1104C, Boston, MA, 02115, USA.
| | - Ferdinand Mugusi
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini J Nagu
- Management and Development for Health, Dar es Salaam, Tanzania.,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1104C, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
29
|
Boillat-Blanco N, Bovet P, Ramaiya KL, Mganga M, Minja LT, Saleh L, Imboden M, Schindler C, Gagneux S, Daubenberger C, Reither K, Probst-Hensch N. Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: a longitudinal case control study. BMC Infect Dis 2016; 16:626. [PMID: 27809789 PMCID: PMC5096317 DOI: 10.1186/s12879-016-1960-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022] Open
Abstract
Background Vitamin D level is inversely associated with tuberculosis (TB) and diabetes (DM). Vitamin D could be a mediator in the association between TB and DM. We examined the associations between vitamin D, TB and DM. Methods Consecutive adults with TB and sex- and age-matched volunteers were included in a case-control study in Dar es Salaam, Tanzania. Glycemia and total vitamin D (25(OH)D) were measured at enrolment and after TB treatment in cases. The association between low 25(OH)D (<75 nmol/l) and TB was evaluated by logistic regression adjusted for age, sex, body mass index, socioeconomic status, sunshine hours, HIV and an interaction between low 25(OH)D and hyperglycemia. Results The prevalence of low 25(OH)D was similar in TB patients and controls (25.8 % versus 31.0 %; p = 0.22). In the subgroup of patients with persistent hyperglycemia (i.e. likely true diabetic patients), the proportion of patients with low 25(OH)D tended to be greater in TB patients (50 % versus 29.7 %; p = 0.20). The effect modification by persistent hyperglycemia persisted in the multivariate analysis (pinteraction = 0.01). Conclusions Low 25(OH)D may increase TB risk in patients with underlying DM. Trials should examine if this association is causal and whether adjunct vitamin D therapy is beneficial in this population. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1960-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Noémie Boillat-Blanco
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,Department of Sciences, University of Basel, Basel, Switzerland. .,Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Kaushik L Ramaiya
- Shree Hindu Mandal Hospital and Muhimbili University of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Maliwasa Mganga
- Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania
| | - Lilian T Minja
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lanja Saleh
- Institute of Clinical Chemistry, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Klaus Reither
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| |
Collapse
|
30
|
Noor RA, Geldsetzer P, Bärnighausen T, Fawzi W. Do countries rely on the World Health Organization for translating research findings into clinical guidelines? A case study. Global Health 2016; 12:58. [PMID: 27716252 PMCID: PMC5053105 DOI: 10.1186/s12992-016-0196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 09/09/2016] [Indexed: 01/01/2023] Open
Abstract
Background The World Health Organization’s (WHO) antiretroviral therapy (ART) guidelines have generally been adopted rapidly and with high fidelity by countries in sub-Saharan Africa. Thus far, however, WHO has not published specific guidance on nutritional care and support for (non-pregnant) adults living with HIV despite a solid evidence base for some interventions. This offers an opportunity for a case study on whether national clinical guidelines in sub-Saharan Africa provide concrete recommendations in the face of limited guidance by WHO. This study, therefore, aims to determine if national HIV treatment guidelines in sub-Saharan Africa contain specific guidance on nutritional care and support for non-pregnant adults living with HIV. Methods We identified the most recent national HIV treatment guidelines in sub-Saharan African countries with English as an official language. Using pre-specified criteria, we determined for each guideline whether it provides guidance to clinicians on each of five components of nutritional care and support for adults living with HIV: assessment of nutritional status, dietary counseling, micronutrient supplementation, ready-to-use therapeutic or supplementary foods, and food subsidies. Results We found that national HIV treatment guidelines in sub-Saharan Africa generally do not contain concrete recommendations on nutritional care and support for non-pregnant adults living with HIV. Conclusions Given that decisions on nutritional care and support are inevitably being made at the clinician-patient level, and that clinicians have a relative disadvantage in systematically identifying, summarizing, and weighing up research evidence compared to WHO and national governments, there is a need for more specific clinical guidance. In our view, such guidance should at a minimum recommend daily micronutrient supplements for adults living with HIV who are in pre-ART stages, regular dietary counseling, periodic assessment of anthropometric status, and additional nutritional management of undernourished patients. More broadly, our findings suggest that countries in sub-Saharan Africa look to WHO for guidance in translating evidence into clinical guidelines. It is, thus, likely that the development of concrete recommendations by WHO on nutritional interventions for people living with HIV would lead to more specific guidelines at the country-level and, ultimately, better clinical decisions and treatment outcomes.
Collapse
Affiliation(s)
- Ramadhani A Noor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Africa Academy for Public Health (AAPH), Plot #802, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Africa Health Research Institute, Mtubatuba, 3935, South Africa.,Institute of Public Health, Heidelberg University, 69120, Heidelberg, Germany
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA
| |
Collapse
|
31
|
Nylén H, Habtewold A, Makonnen E, Yimer G, Bertilsson L, Burhenne J, Diczfalusy U, Aklillu E. Prevalence and risk factors for efavirenz-based antiretroviral treatment-associated severe vitamin D deficiency: A prospective cohort study. Medicine (Baltimore) 2016; 95:e4631. [PMID: 27559961 PMCID: PMC5400328 DOI: 10.1097/md.0000000000004631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
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, 4, 16, and 48 week of cART. Plasma efavirenz concentrations were determined at 4 and 16 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 4, 16, and 48 weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by -40%, -50%, and -14% at 4, 16, and 48 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 4 and 16 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.
Collapse
Affiliation(s)
- Hanna Nylén
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Abiy Habtewold
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leif Bertilsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Ulf Diczfalusy
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Eleni Aklillu
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Correspondence: Professor Eleni Aklillu, Division of Clinical Pharmacology, Department of Laboratory of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge C-168, SE-141 86 Stockholm, Sweden (e-mail: )
| |
Collapse
|
32
|
Nunnari G, Fagone P, Lazzara F, Longo A, Cambria D, Di Stefano G, Palumbo M, Malaguarnera L, Di Rosa M. Vitamin D3 inhibits TNFα-induced latent HIV reactivation in J-LAT cells. Mol Cell Biochem 2016; 418:49-57. [PMID: 27295094 DOI: 10.1007/s11010-016-2732-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
1,25-Dihydroxyvitamin D3 (1,25(OH)2D3) is known to suppress NF-kB activity by interfering with its pathways. The aim of this study was to investigate the ability of 1,25(OH)2D3 in reducing the reactivation of the HIV virus J-LAT cells, an established model of latently infected cells, which were treated with TNFalpha (100 ng/ml) for 2 h with or without 24 h 1,25(OH)2D3 (100 nM) pretreatment. Reactivation of HIV RNA in J-LAT was evaluated in terms of green fluorescent protein (GFP) expression. The same experimental setting was repeated on T cells from HIV-infected patients. Treatment with TNFalpha was associated with a 16 % increase in GFP+ cells and a five-fold increase in unspliced HIV RNA expression (p < 0.04). Pretreatment of J-LAT cells with 1,25(OH)2D3 for 24 h followed by TNFalpha (100 ng/ml) for 2 h reduced the percentage of GFP+ cells by 8 %; moreover, a 2.4-fold decrease in unspliced HIV RNA expression was observed (p < 0.002). In T cells from patients, treatment with TNFalpha significantly increased unspliced HIV RNA expression (sixfold increase, p < 0.02), whereas prestimulation with 1,25(OH)2D3 reduced its expression (2.5-fold decrease, p < 0.02) compared to controls.1,25(OH)2D3 is able to reduce the ability of TNFalpha to upregulate the transcription of HIV RNA from latently infected cells. These data provide further understanding of the pathogenic mechanisms regulating viral reactivation from latent reservoirs, along with new insight in viral internalization.
Collapse
Affiliation(s)
- G Nunnari
- Unit of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - P Fagone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - F Lazzara
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - A Longo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - D Cambria
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - G Di Stefano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - M Palumbo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - L Malaguarnera
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Michelino Di Rosa
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
| |
Collapse
|
33
|
Tuberculosis incidence rate and risk factors among HIV-infected adults with access to antiretroviral therapy. AIDS 2015; 29:1391-9. [PMID: 26091295 DOI: 10.1097/qad.0000000000000705] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study is to determine the incidence rate and risk factors of tuberculosis (TB) among HIV-infected adults accessing antiretroviral therapy (ART) in Tanzania. DESIGN A prospective observational study among HIV-infected adults attending HIV clinics in Dar es Salaam. METHODS We estimated TB incidence rates among HIV-infected patients prior to and after ART initiation. We used Cox proportional hazard regressions to determine the predictors of incident TB among HIV-infected adults enrolled in the HIV care and treatment programme. RESULTS We assessed 67 686 patients for a median follow-up period of 24 (interquartile range: 8-49) months; 7602 patients were diagnosed with active TB. The TB incidence rate was 7.9 [95% confidence interval (95% CI), 7.6-8.2] per 100 person-years prior to ART initiation, and 4.4 (95% CI, 4.2-4.4) per 100 person-years for patients receiving ART. In multivariate analyses, patients on ART in the first 3 months had a 57% higher risk of TB (hazard ratio: 1.57, 95% CI, 1.47-1.68) than those not on ART, but the risk significantly decreased with increasing duration of ART. Risk factors for incident TB included being male, having low BMI or middle upper arm circumference, lower CD4 cell count and advanced WHO disease stage. There was seasonal variation for incident TB, with higher risk observed following the rainy seasons (May, June and November). CONCLUSION In TB endemic regions, HIV-infected patients initiating ART, particularly men and those with poor nutritional status, should be closely monitored for active TB at ART initiation. In addition to increasing the access to ART, interventions should be considered to improve nutritional status among HIV-infected patients.
Collapse
|
34
|
Facchini L, Venturini E, Galli L, Martino MD, Chiappini E. Vitamin D and tuberculosis: a review on a hot topic. J Chemother 2015; 27:128-38. [DOI: 10.1179/1973947815y.0000000043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
35
|
Keflie TS, Nölle N, Lambert C, Nohr D, Biesalski HK. Vitamin D deficiencies among tuberculosis patients in Africa: A systematic review. Nutrition 2015; 31:1204-12. [PMID: 26333888 DOI: 10.1016/j.nut.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/11/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to explore the existence of vitamin D deficiency (VDD) in tuberculosis (TB) patients living in Africa and to identify its predictor variables. PRISMA guidelines and checklists were used. The sources of the data were Medline/PubMed, Web of Science, Scopus, and Google Scholar databases. We identified 23 articles, of which 15 reported the status of vitamin D in TB with TB. The definition of serum vitamin D status was summarized as severe, deficient, and insufficient when the concentration of 25-hydroxyvitamin (OH)-D ≤25, ≤50, and ≤75 nmol/L, respectively. The reports showed that up to 88.9% and 96.3% of patients with TB tested by radioimmunoassay had VDD and vitamin D insufficiency, respectively. Statistically significant variables such as lack of sun exposure, inadequate dietary intake, season, clothing, comorbidities, low body mass index, age, skin pigmentation, use of antiretroviral therapy and anti-TB drugs, and socioeconomic status were identified as the main predictor variables of vitamin D status. VDD and vitamin D insufficiency were highly prevalent in TB patients in Africa. Further case-control studies are warranted to clarify the cause-effect relationship between vitamin D and TB and thereby, design valuable strategies to manage VDD among TB patients in Africa.
Collapse
Affiliation(s)
- Tibebeselassie Seyoum Keflie
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany; Food Security Center, University of Hohenheim, Stuttgart, Germany.
| | - Nils Nölle
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Christine Lambert
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Donatus Nohr
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany; Food Security Center, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
36
|
Zeng J, Wu G, Yang W, Gu X, Liang W, Yao Y, Song Y. A serum vitamin D level <25nmol/l pose high tuberculosis risk: a meta-analysis. PLoS One 2015; 10:e0126014. [PMID: 25938683 PMCID: PMC4418705 DOI: 10.1371/journal.pone.0126014] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/27/2015] [Indexed: 01/08/2023] Open
Abstract
Background Low 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. Methods A 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). Results A 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). Conclusions This 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.
Collapse
Affiliation(s)
- Junli Zeng
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China 210002
| | - Guannan Wu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Xiaoling Gu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Wenjun Liang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Yanwen Yao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China 210002
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
- * E-mail:
| |
Collapse
|
37
|
Vitamin D Deficiency in HIV Infection: Not Only a Bone Disorder. BIOMED RESEARCH INTERNATIONAL 2015; 2015:735615. [PMID: 26000302 PMCID: PMC4426898 DOI: 10.1155/2015/735615] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 01/01/2023]
Abstract
Hypovitaminosis D is a worldwide disorder, with a high prevalence in the general population of both Western and developing countries. In HIV patients, several studies have linked vitamin D status with bone disease, neurocognitive impairment, depression, cardiovascular disease, high blood pressure, metabolic syndrome, type 2 diabetes mellitus, infections, autoimmune diseases like type 1 diabetes mellitus, and cancer. In this review, we focus on the most recent epidemiological and experimental data dealing with the relationship between vitamin D deficiency and HIV infection. We analysed the extent of the problem, pathogenic mechanisms, clinical implications, and potential benefits of vitamin D supplementation in HIV-infected subjects.
Collapse
|
38
|
Vitamin D deficiency and altered bone mineral metabolism in HIV-infected individuals. Curr HIV/AIDS Rep 2015; 11:263-70. [PMID: 24962286 DOI: 10.1007/s11904-014-0218-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Although patients with HIV infection are living decades longer than before with the advent of combination antiretroviral therapy, they have an increased rate of co-morbidities associated with chronic HIV, such as osteoporosis, cardiovascular disease, and immune dysfunction. Many of these complications are known to be affected by vitamin D status in the general population. Thus, the high rate of vitamin D deficiency among HIV-infected patients is alarming. Many observational and cohort studies have demonstrated that vitamin D deficiency is associated with these HIV-related complications, but randomized, placebo-controlled trials are limited. This paper reviews recent data on vitamin D deficiency in HIV infection.
Collapse
|
39
|
Sudfeld CR, Duggan C, Aboud S, Kupka R, Manji KP, Kisenge R, Fawzi WW. Vitamin D status is associated with mortality, morbidity, and growth failure among a prospective cohort of HIV-infected and HIV-exposed Tanzanian infants. J Nutr 2015; 145:121-7. [PMID: 25527666 PMCID: PMC4264018 DOI: 10.3945/jn.114.201566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin D is a potent immunomodulator, but its impact on morbidity and mortality among infants remains unclear. OBJECTIVE The objective of the study was to prospectively assess the association of vitamin D status with mortality, morbidity, and growth during the first 2 y of life. METHODS A prospective cohort of 253 HIV-infected and 948 HIV-exposed Tanzanian infants enrolled in a randomized trial of multivitamins (not including vitamin D) was studied. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured at 5-7 wk of age and infants were followed at monthly clinic visits until 24 mo. Physicians performed a clinical exam every 3 mo or when an illness was noted. RESULTS Serum 25(OH)D concentrations were (means ± SDs) 18.6 ± 10.3 ng/mL and 18.1 ± 9.2 ng/mL for HIV-infected and HIV-exposed infants, respectively. Unexpectedly, serum 25(OH)D concentrations ≥30 ng/mL were significantly associated with higher mortality as compared to the 20-29.9 ng/mL reference for HIV-infected (HR: 2.47; 95% CI: 1.13, 5.44; P = 0.02) and HIV-exposed (HR: 4.00; 95% CI: 1.67, 9.58; P < 0.01) infants after multivariate adjustment. We found no statistically significant association between 25(OH)D concentrations <10 ng/mL and mortality for HIV-infected (HR: 1.43; 95% CI: 0.74, 2.78; P = 0.29) and HIV-exposed (HR: 1.56; 95% CI: 0.60, 4.03; P = 0.36) infants. Among HIV-exposed infants, 25(OH)D concentrations ≥30 ng/mL were significantly associated with clinical [incidence ratio rate (IRR): 1.34; 95% CI: 1.06,1.70; P = 0.02] and confirmed (IRR: 1.71; 95% CI: 1.71; 1.15, 2.54; P < 0.01) malaria diagnoses, whereas concentrations of <10 ng/mL were associated with oral candidiasis (IRR: 1.47; 95% CI: 1.00-2.15; P = 0.046) and wasting (HR: 1.71; 95% CI: 1.20, 2.43; P < 0.01). CONCLUSION The observational design of this study does not allow for causal interpretation; however, the results indicate a strong need for additional studies of vitamin D among HIV-infected and -exposed children, particularly in malaria-endemic settings. The parent trial was registered at clinicaltrials.gov as NCT00197730.
Collapse
Affiliation(s)
| | - Christopher Duggan
- Nutrition, and,Division of Gastroenterology and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, MA; Departments of
| | | | - Roland Kupka
- Nutrition, and,UNICEF Headquarters, New York, NY
| | - Karim P Manji
- Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Rodrick Kisenge
- Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Wafaie W Fawzi
- Departments of Global Health and Population,,Nutrition, and,Epidemiology, Harvard School of Public Health, Boston, MA
| |
Collapse
|
40
|
|
41
|
Vitamin D status and incidence of tuberculosis infection conversion in contacts of pulmonary tuberculosis patients: a prospective cohort study. Epidemiol Infect 2014; 143:1731-41. [PMID: 25274036 DOI: 10.1017/s0950268814002386] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to estimate the relationship between serum vitamin D (VitD) status and tuberculosis (TB) infection conversion (TBIC), measured by the tuberculin skin test (TST) and an interferon-gamma release assay, the QuantiFERON-TB Gold In-Tube (QFT-GIT) test, in the contacts of pulmonary TB patients in Castellon (Spain) in a prospective cohort study from 2010 to 2012. Initially, the participants were negative to latent TB infection after a screening that included TST and QFT-GIT tests, and other examinations. A baseline determination of 25-hydroxyvitamin D [25(OH)D] was obtained by chemiluminescence immunoassay. After 8-10 weeks, participants were screened for a second time to determine TB infection conversion (TBIC). Poisson regression models were used in the statistical analysis. Of the 247 participants in the cohort, 198 (80·2%) were screened twice and 18 (9·1%) were TBIC cases. The means of VitD concentration in the TBIC cases and the non-cases were 20·7±11·9 and 27·2±11·4 ng/ml (P = 0·028), respectively. Adjusted for high exposure and TB sputum acid-fast bacilli (AFB)-positive index case, higher serum VitD concentration was associated with low incidence of TBIC (P trend = 0·005), and an increase of 1 ng/ml VitD concentration decreased the incidence of TBIC by 6% (relative risk 0·94, 95% confidence interval 0·90-0·99, P = 0·015). The results suggest that sufficient VitD level could be a protective factor of TBIC.
Collapse
|
42
|
Escota GV, Cross S, Powderly WG. Vitamin D and calcium abnormalities in the HIV-infected population. Endocrinol Metab Clin North Am 2014; 43:743-67. [PMID: 25169565 DOI: 10.1016/j.ecl.2014.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of vitamin D deficiency among HIV-infected persons is substantial and comparable to the general population. The factors associated with vitamin D deficiency are similar for both populations but additional factors (ie, use of certain antiretroviral agents) also contribute to vitamin D deficiency among HIV-infected persons. The adverse outcomes associated with vitamin D deficiency considerably overlap with non-AIDS defining illnesses (NADIs) that are increasingly becoming widespread in the aging HIV-infected population. However, there is scant evidence to support any causal inference. Further studies are warranted as efforts to identify and address modifiable risk factors contributing to NADIs continue.
Collapse
Affiliation(s)
- Gerome V Escota
- Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA
| | - Sara Cross
- Division of Infectious Diseases, University of Tennessee Health Sciences Center, 956 Court Avenue, E336 Coleman Building, Memphis, TN 38163, USA
| | - William G Powderly
- Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA.
| |
Collapse
|
43
|
Gao WW, Wang Y, Zhang XR, Yin CY, Hu CM, Tian M, Wang HW, Zhang X. Levels of 1,25(OH)2D3 for patients with pulmonary tuberculosis and correlations of 1,25(OH)2D3 with the clinical features of TB. J Thorac Dis 2014; 6:760-4. [PMID: 24977000 DOI: 10.3978/j.issn.2072-1439.2014.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/15/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND To determine the 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] concentrations to patients with tuberculosis (TB) and whether it influenced the patient's clinical features. METHODS For the first part, a total of 153 healthy adults and 74 patients with pulmonary TB (PTB) were enrolled. Serum concentrations of 1,25(OH)2D3 were determined by liquid chromatography-tandem mass spectroscopy to examine the 1,25(OH)2D3 concentrations of the two groups from the peripheral blood. If there are differences between the two groups, what follow will increase the experimental group numbers to examine the relationship among the 1,25(OH)2D3 concentrations with the numbers of the lesion area, the tubercule bacilli in sputum and the CD4/CD8 ratio of T lymphocytes in the peripheral blood. RESULTS In the first part, the 1,25(OH)2D3 concentrations was lower in patients with TB than in those healthy adults [365.9 (SD 235.7) vs. 464.3 (SD 335.6), P<0.05]. In the second part, we increased the sample size to 134 (male 91 cases, female 43 cases). we found that the plasma levels of 1,25(OH)2D3 are not correlated with the numbers of the lesion area and the tubercule bacilli in sputum, but the 1,25(OH)2D3 levels can interact the ratio of CD4/CD8 T lymphocytes, it shows a positive correlation with the ratio of CD4/CD8 T lymphocytes. CONCLUSIONS The 1,25(OH)2D3 concentrations in TB patients lower than the healthy adults, it might exist as a risk factor during the development of TB or TB might affect the levels of 1,25(OH)2D3. But the different status vitamin D concentration might not affect the numbers of the lesion area, the tubercule bacilli in sputum. It shows a positive correlation with the ratio of CD4/CD8 T lymphocytes. The study will have a significance value to clinical medicine, but further study will need to study the levels of 1,25(OH)2D3 with the TB.
Collapse
Affiliation(s)
- Wei-Wei Gao
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Yu Wang
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Xiang-Rong Zhang
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Chun-Yang Yin
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Chun-Mei Hu
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Man Tian
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Hong-Wei Wang
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| | - Xia Zhang
- 1 Department of Tuberculosis, Nanjing Chest Hospital, Nanjing 210029, China ; 2 Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China ; 3 Department of Respiratory Medicine, Nanjing Children's Hospital Affiliated with Nanjing Medical University, Nanjing 210008, China
| |
Collapse
|
44
|
He X, Yan J, Zhu X, Wang Q, Pang W, Qi Z, Wang M, Luo E, Parker DM, Cantorna MT, Cui L, Cao Y. Vitamin D inhibits the occurrence of experimental cerebral malaria in mice by suppressing the host inflammatory response. THE JOURNAL OF IMMUNOLOGY 2014; 193:1314-23. [PMID: 24965778 DOI: 10.4049/jimmunol.1400089] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In animal models of experimental cerebral malaria (ECM), neuropathology is associated with an overwhelming inflammatory response and sequestration of leukocytes and parasite-infected RBCs in the brain. In this study, we explored the effect of vitamin D (VD; cholecalciferol) treatment on host immunity and outcome of ECM in C57BL/6 mice during Plasmodium berghei ANKA (PbA) infection. We observed that oral administration of VD both before and after PbA infection completely protected mice from ECM. VD administration significantly dampened the inducible systemic inflammatory responses with reduced circulating cytokines IFN-γ and TNF and decreased expression of these cytokines by the spleen cells. Meanwhile, VD also resulted in decreased expression of the chemokines CXCL9 and CXCL10 and cytoadhesion molecules (ICAM-1, VCAM-1, and CD36) in the brain, leading to reduced accumulation of pathogenic T cells in the brain and ultimately substantial improvement of the blood-brain barriers of PbA-infected mice. In addition, VD inhibited the differentiation, activation, and maturation of splenic dendritic cells. Meanwhile, regulatory T cells and IL-10 expression levels were upregulated upon VD treatment. These data collectively demonstrated the suppressive function of VD on host inflammatory responses, which provides significant survival benefits in the murine ECM model.
Collapse
Affiliation(s)
- Xiyue He
- Department of Immunology, China Medical University, Shenyang 110001, China
| | - Juan Yan
- Department of Immunology, China Medical University, Shenyang 110001, China
| | - Xiaotong Zhu
- Department of Immunology, China Medical University, Shenyang 110001, China; Department of Entomology, Pennsylvania State University, University Park, PA 16802; and
| | - Qinghui Wang
- Department of Immunology, China Medical University, Shenyang 110001, China; Institute of Pathology and Pathophysiology, China Medical University, Shenyang 110001, China
| | - Wei Pang
- Department of Immunology, China Medical University, Shenyang 110001, China
| | - Zanmei Qi
- Department of Immunology, China Medical University, Shenyang 110001, China
| | - Meilian Wang
- Department of Microbiology and Parasitology, China Medical University, Shenyang 110001, China
| | - Enjie Luo
- Department of Microbiology and Parasitology, China Medical University, Shenyang 110001, China
| | - Daniel M Parker
- Department of Entomology, Pennsylvania State University, University Park, PA 16802; and
| | - Margherita T Cantorna
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA 16802
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, University Park, PA 16802; and
| | - Yaming Cao
- Department of Immunology, China Medical University, Shenyang 110001, China;
| |
Collapse
|
45
|
Jarvis JN, Bicanic T, Loyse A, Meintjes G, Hogan L, Roberts CH, Shoham S, Perfect JR, Govender NP, Harrison TS. Very low levels of 25-hydroxyvitamin D are not associated with immunologic changes or clinical outcome in South African patients with HIV-associated cryptococcal meningitis. Clin Infect Dis 2014; 59:493-500. [PMID: 24825871 PMCID: PMC4111915 DOI: 10.1093/cid/ciu349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitamin D deficiency may increase susceptibility to opportunistic infections in HIV-infected individuals. We found no evidence that vitamin D deficiency increases risk of cryptococcal meningitis or leads to impaired immune responses or microbiological clearance in HIV-infected patients with cryptococcal meningitis. Background. Vitamin D deficiency is associated with impaired immune responses and increased susceptibility to a number of intracellular pathogens in individuals infected with human immunodeficiency virus (HIV). It is not known whether such an association exists with Cryptococcus neoformans. Methods. Levels of 25-hydroxyvitamin D (25[OH]D) were measured in 150 patients with cryptococcal meningitis (CM) and 150 HIV-infected controls in Cape Town, South Africa, and associations between vitamin D deficiency and CM were examined. The 25-hydroxyvitamin D levels and cryptococcal notifications were analyzed for evidence of reciprocal seasonality. Associations between 25(OH)D levels and disease severity, immune responses, and microbiological clearance were investigated in the patients with CM. Results. Vitamin D deficiency (plasma 25[OH]D ≤50 nmol/L) was present in 74% of patients. Vitamin D deficiency was not associated with CM (adjusted odds ratio, 0.93 [95% confidence interval, .6–1.6]; P = .796). Levels of 25(OH)D showed marked seasonality, but no reciprocal seasonality was seen in CM notifications. No significant associations were found between 25(OH)D levels and fungal burden or levels of tumor necrosis factor α, interferon γ, interleukin 6, soluble CD14, or neopterin in cerebrospinal fluid. Rates of fungal clearance did not vary according to vitamin D status. Conclusions. Vitamin D deficiency does not predispose to the development of CM, or lead to impaired immune responses or microbiological clearance in HIV-infected patients with CM.
Collapse
Affiliation(s)
- Joseph N Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom Botswana-University of Pennsylvania Partnership, Gaborone, Botswana Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tihana Bicanic
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Angela Loyse
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Graeme Meintjes
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa Department of Medicine, Imperial College London, United Kingdom
| | - Louise Hogan
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Chrissy H Roberts
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John R Perfect
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Nelesh P Govender
- National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas S Harrison
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| |
Collapse
|
46
|
Havers F, Smeaton L, Gupte N, Detrick B, Bollinger RC, Hakim J, Kumarasamy N, Andrade A, Christian P, Lama JR, Campbell TB, Gupta A. 25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings. J Infect Dis 2014; 210:244-53. [PMID: 24799602 DOI: 10.1093/infdis/jiu259] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking. METHODS A case-cohort study (N = 411) was nested within a randomized cART trial of 1571 cART-naive adults in 8 resource-limited settings and the United States. The primary outcome (WHO stage 3/4 disease or death within 96 weeks of cART initiation) was met by 192 cases, and 152 and 29 cases met secondary outcomes of virologic and immunologic failure. We studied prevalence and risk factors for baseline low 25(OH)D (<32 ng/mL) and examined associated outcomes using proportional hazard models. RESULTS Low 25(OH)D prevalence was 49% and ranged from 27% in Brazil to 78% in Thailand. Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09-4.18) and virologic failure (aHR 2.42; 95% CI, 1.33-4.41). CONCLUSIONS Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure. Studies examining the potential benefit of vitamin D supplementation among HIV patients initiating cART are warranted.
Collapse
Affiliation(s)
- Fiona Havers
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Smeaton
- Bloomberg School of Public Health, Johns Hopkins University
| | - Nikhil Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland HIV Clinical Trials Unit, B.J. Medical College, Pune, India
| | - Barbara Detrick
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert C Bollinger
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Bloomberg School of Public Health, Johns Hopkins University HIV Clinical Trials Unit, B.J. Medical College, Pune, India
| | - James Hakim
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Adriana Andrade
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Javier R Lama
- IMPACTA PERU Clinical Trials Unit, Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Thomas B Campbell
- Division of Infectious Diseases, University of Colorado Denver, Aurora
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Bloomberg School of Public Health, Johns Hopkins University HIV Clinical Trials Unit, B.J. Medical College, Pune, India
| | | | | |
Collapse
|
47
|
Borella E, Nesher G, Israeli E, Shoenfeld Y. Vitamin D: a new anti-infective agent? Ann N Y Acad Sci 2014; 1317:76-83. [PMID: 24593793 DOI: 10.1111/nyas.12321] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Before the antibiotic era, treatment of tuberculosis patients was restricted to sun exposure in sanatoria. Years later, it was found that 1,25-dihydroxyvitamin D3 stimulates production of cathelicidins, a family of polypeptides found in lysosomes of macrophages and polymorphonuclear leukocytes. Cathelicidins serve a critical role in innate immune defense, which plays an important role in the suppression of Mycobacterium infections and other pathogens. It is believed that the increased incidence of the common cold and pneumonia during winter is related, in part, to decreased exposure to sunlight, resulting in a decreased synthesis of 1,25-dihydroxyvitamin D3. An association has been established between low levels of vitamin D and upper respiratory and enteric infections, pneumonia, otitis media, Clostridium infections, vaginosis, urinary tract infections, sepsis, influenza, dengue, hepatitis B, hepatitis C, and HIV infections. Accumulating evidence suggests that 1,25-dihydroxyvitamin D3 exerts protective effects during infections by upregulating the expression of cathelicidin and β-defensin 2 in phagocytes and epithelial cells. Vitamin D may be acting as a panaceal antibiotic agent and thus may be useful as an adjuvant therapy in diverse infections.
Collapse
Affiliation(s)
- Elisabetta Borella
- Division of Rheumatology, Department of Medicine, University of Padua, Padua, Italy; Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center at Tel Hashomer, Tel Aviv, Israel
| | | | | | | |
Collapse
|
48
|
Coussens AK, Martineau AR, Wilkinson RJ. Anti-Inflammatory and Antimicrobial Actions of Vitamin D in Combating TB/HIV. SCIENTIFICA 2014; 2014:903680. [PMID: 25101194 PMCID: PMC4102066 DOI: 10.1155/2014/903680] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/23/2014] [Indexed: 05/08/2023]
Abstract
TUBERCULOSIS (TB) DISEASE ACTIVATION IS NOW BELIEVED TO ARISE DUE TO A LACK OF INFLAMMATORY HOMEOSTATIC CONTROL AT EITHER END OF THE SPECTRUM OF INFLAMMATION: either due to immunosuppression (decreased antimicrobial activity) or due to immune activation (excess/aberrant inflammation). Vitamin D metabolites can increase antimicrobial activity in innate immune cells, which, in the context of HIV-1 coinfection, have insufficient T cell-mediated help to combat Mycobacterium tuberculosis (MTB) infection. Moreover, maintaining vitamin D sufficiency prior to MTB infection enhances the innate antimicrobial response to T cell-mediated interferon-γ. Conversely, vitamin D can act to inhibit expression and secretion of a broad range of inflammatory mediators and matrix degrading enzymes driving immunopathology during active TB and antiretroviral- (ARV-) mediated immune reconstitution inflammatory syndrome (IRIS). Adjunct vitamin D therapy during treatment of active TB may therefore reduce lung pathology and TB morbidity, accelerate resolution of cavitation and thereby decrease the chance of transmission, improve lung function following therapy, prevent relapse, and prevent IRIS in those initiating ARVs. Future clinical trials of vitamin D for TB prevention and treatment must be designed to detect the most appropriate primary endpoint, which in some cases should be anti-inflammatory and not antimicrobial.
Collapse
Affiliation(s)
- Anna K. Coussens
- Clinical Infectious Diseases Research Initiative, University of Cape Town, Observatory, Western Cape 7925, South Africa
- *Anna K. Coussens:
| | - Adrian R. Martineau
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AB, UK
| | - Robert J. Wilkinson
- Clinical Infectious Diseases Research Initiative, University of Cape Town, Observatory, Western Cape 7925, South Africa
- MRC National Institute for Medical Research, UK Medical Research Council, London NW7 1AA, UK
- Department of Medicine, Imperial College London, London W2 1PG, UK
| |
Collapse
|
49
|
Mehta S, Mugusi FM, Bosch RJ, Aboud S, Urassa W, Villamor E, Fawzi WW. Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study. BMJ Open 2013; 3:e003703. [PMID: 24247327 PMCID: PMC3840339 DOI: 10.1136/bmjopen-2013-003703] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status. DESIGN Cohort study. SETTING Outpatient clinics in Tanzania. PARTICIPANTS 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) initiating anti-TB treatment at enrolment in a multivitamin supplementation (excluding vitamin D) trial (Clinicaltrials.gov identifier: NCT00197704). PRIMARY AND SECONDARY OUTCOME MEASURES Information on treatment outcomes such as failure and relapse, HIV disease progression, T-cell counts and anthropometry was collected routinely, with a median follow-up of 52 and 30 months for HIV-uninfected and HIV-infected patients, respectively. Cox and binomial regression, and generalised estimating equations were used to assess the association of vitamin D status with these outcomes. RESULTS Mean 25-hydroxyvitamin D concentrations at enrolment were 69.8 (±21.5) nmol/L (27.9 (±8.6) ng/mL). Vitamin D insufficiency (<75 nmol/L) was associated with a 66% higher risk of relapse (95% CI 4% to 164%; 133% higher risk in HIV-uninfected patients). Each unit higher 25-hydroxyvitamin D levels at baseline were associated with a decrease of 3 (p=0.004) CD8 and 3 (p=0.01) CD3 T-cells/µL during follow-up in patients with HIV infection. Vitamin D insufficiency was also associated with a greater decrease of body mass index (BMI; -0.21 kg/m(2); 95% CI -0.39 to -0.02), during the first 8 months of follow-up. No association was observed for vitamin D status with mortality or HIV disease progression. CONCLUSIONS Adequate vitamin D status is associated with a lower risk of relapse and with improved nutritional indicators such as BMI in patients with TB, with or without HIV infection. Further research is needed to determine the optimal dose of vitamin D and effectiveness of daily vitamin D supplementation among patients with TB.
Collapse
Affiliation(s)
- Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ronald J Bosch
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Willy Urassa
- Diagnostics and Laboratory Technology Team, World Health Organization, Geneva, Switzerland
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
50
|
Legeai C, Vigouroux C, Souberbielle JC, Bouchaud O, Boufassa F, Bastard JP, Carlier R, Capeau J, Goujard C, Meyer L, Viard JP. Associations between 25-hydroxyvitamin D and immunologic, metabolic, inflammatory markers in treatment-naive HIV-infected persons: the ANRS CO9 «COPANA» cohort study. PLoS One 2013; 8:e74868. [PMID: 24058636 PMCID: PMC3776742 DOI: 10.1371/journal.pone.0074868] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 08/09/2013] [Indexed: 01/08/2023] Open
Abstract
Objectives Low 25(OH)D has been associated with dyslipidemia, insulin resistance and inflammation in both general and HIV-infected (mostly treated) populations. We investigated these associations in antiretroviral-naïve HIV-infected persons. Design We measured plasma 25(OH)D, metabolic, immunologic and inflammatory markers in 355 persons (204 Whites, 151 Blacks) at enrollment in the ANRS COPANA cohort. Methods 25(OH)D levels were categorized <10 ng/mL (severe deficiency) and <20 ng/mL (deficiency). Statistical analyses were adjusted for sampling season, ethnicity and the interaction between season and ethnicity. Results 25(OH)D insufficiency (<30 ng/mL), deficiency (<20 ng/mL) and severe deficiency (<10 ng/mL) were highly prevalent (93%, 67% and 24% of patients, respectively). Blacks had significantly lower 25(OH)D than Whites (median: 13 vs. 17 ng/mL, P<0.001), with markedly less pronounced seasonal variation. Smoking and drinking alcohol were associated with having a 25 OHD level<10 ng/mL. In patients with 25(OH)D<10 ng/mL, the proportion of persons with a CD4 count<100/mm3 was higher than in patients with 25(OH)D≥10 ng/mL (18.8% vs. 10.7%, P = 0.04). Persons with 25 OHD<10 ng/mL had higher levels of hsCRP (1.60 mg/L [IQR: 0.59–5.76] vs. 1.27 mg/L [0.58–3,39], P = 0.03) and resistin (16.81 ng/L [IQR: 13.82–25.74] vs. 11.56 ng/L [IQR: 8.87–20.46], P = 0.02), and, among Blacks only, sTNFR2 (2.92 ng/mL [2.31–4.13] vs. 2.67 ng/mL, [1.90–3.23], P = 0.04). The strength and significance of the association between CD4<100/mm3 and 25 OHD<10 ng/mL were reduced after adjustment on sTNFR1, sTNFR2, and hsCRP levels. In multivariate analysis, a CD4 count <100/mm3, resistin concentration and smoking were independently associated with 25(OH)D<10 ng/mL. Conclusions Severe vitamin D deficiency was associated with low CD4 counts and increased markers of inflammation in ARV-naïve HIV-infected persons.
Collapse
Affiliation(s)
- Camille Legeai
- Institut National de la Santé et de la Recherche Médicale (INSERM), unité mixte de recherche et de service (UMRS) 1018, équipe « Epidémiologie du VIH et des infections sexuellement transmissibles », centre de recherche en épidémiologie et santé des populations (CESP)-INSERM U1018, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Corinne Vigouroux
- Assistance Publique-Hôpitaux de Paris, hôpital Tenon, service de biochimie et hormonologie, Paris, France
- INSERM UMRS938, centre de recherche Saint-Antoine, Paris, France
- Université Pierre et Marie Curie-Paris 06, institute of cardiometabolism and nutrition (ICAN), Paris, France
| | - Jean-Claude Souberbielle
- Assistance Publique-Hôpitaux de Paris, service d’explorations fonctionnelles, hôpital Necker, Paris, France
| | - Olivier Bouchaud
- Assistance Publique-Hôpitaux de Paris, service des maladies infectieuses, hôpital Avicenne, Bobigny, France
- Université Paris-Nord, Bobigny, France
| | - Faroudy Boufassa
- Institut National de la Santé et de la Recherche Médicale (INSERM), unité mixte de recherche et de service (UMRS) 1018, équipe « Epidémiologie du VIH et des infections sexuellement transmissibles », centre de recherche en épidémiologie et santé des populations (CESP)-INSERM U1018, Le Kremlin-Bicêtre, France
| | - Jean-Philippe Bastard
- Assistance Publique-Hôpitaux de Paris, hôpital Tenon, service de biochimie et hormonologie, Paris, France
- INSERM UMRS938, centre de recherche Saint-Antoine, Paris, France
| | - Robert Carlier
- Assistance Publique-Hôpitaux de Paris, service de radiologie et imagerie médicale, hôpital Raymond-Poincaré, Garches, France
| | - Jacqueline Capeau
- Assistance Publique-Hôpitaux de Paris, hôpital Tenon, service de biochimie et hormonologie, Paris, France
- INSERM UMRS938, centre de recherche Saint-Antoine, Paris, France
- Université Pierre et Marie Curie-Paris 06, institute of cardiometabolism and nutrition (ICAN), Paris, France
| | - Cécile Goujard
- Institut National de la Santé et de la Recherche Médicale (INSERM), unité mixte de recherche et de service (UMRS) 1018, équipe « Epidémiologie du VIH et des infections sexuellement transmissibles », centre de recherche en épidémiologie et santé des populations (CESP)-INSERM U1018, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris, service de médecine interne, hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), unité mixte de recherche et de service (UMRS) 1018, équipe « Epidémiologie du VIH et des infections sexuellement transmissibles », centre de recherche en épidémiologie et santé des populations (CESP)-INSERM U1018, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris, service d’épidémiologie et de santé publique, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Paul Viard
- Assistance Publique-Hôpitaux de Paris, centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu, Paris, France
- Equipe d’accueil 3620, Université Paris Descartes, Paris, France
- * E-mail:
| | | |
Collapse
|