A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis.
BACKGROUND
Tuberculosis (TB) often coincides with nutritional deficiencies. The effects of micronutrient supplementation on TB treatment outcomes, clinical complications, and mortality are uncertain.


METHODS
We conducted a randomized, double-blind, placebo-controlled trial of micronutrients (vitamins A, B complex, C, and E, as well as selenium) in Dar es Salaam, Tanzania. We enrolled 471 human immunodeficiency virus (HIV)-infected and 416 HIV-negative adults with pulmonary TB at the time of initiating chemotherapy and monitored them for a median of 43 months.


RESULTS
Micronutrients decreased the risk ofTB recurrence by 45% overall (95% confidence interval [CI], 7% to 67%; P = .02) and by 63% in HIV-infected patients (95% CI, 8% to 85%; P = .02). There were no significant effects on mortality overall; however, we noted a marginally significant 64% reduction of deaths in HIV-negative subjects (95% CI, -14% to 88%; P = .08). Supplementation increased CD3+ and CD4+ cell counts and decreased the incidence of extrapulmonary TB and genital ulcers in HIV-negative patients. Micronutrients reduced the incidence of peripheral neuropathy by 57% (95% CI, 41% to 69%; P < .001), irrespective of HIV status. There were no significant effects on weight gain, body composition, anemia, or HIV load.


CONCLUSIONS
Micronutrient supplementation could improve the outcome in patients undergoing TB chemotherapy in Tanzania.
Villamor
Eduardo
E
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. evillamo@hsph.harvard.edu
Mugusi
Ferdinand
F
Urassa
Willy
W
Bosch
Ronald J
RJ
Saathoff
Elmar
E
Matsumoto
Kenji
K
Meydani
Simin N
SN
Fawzi
Wafaie W
WW
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use*; D055502:Secondary Prevention; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D013636:Tanzania; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000276:immunology / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy*
D018977:Micronutrients