The effect of vitamin A and zinc supplementation on treatment outcomes in pulmonary tuberculosis: a randomized controlled trial.
BACKGROUND
Low serum concentrations of vitamin A and zinc are common in tuberculosis and may have an adverse effect on host cell-mediated responses. The role of adjunctive micronutrient supplementation on treatment outcomes is uncertain.


OBJECTIVE
The objective was to assess the efficacy of vitamin A and zinc supplementation on sputum smear and culture conversion and time to culture detection in adults with sputum smear-positive pulmonary tuberculosis.


METHODS
Participants attending a primary care tuberculosis clinic in Cape Town, South Africa, were randomly assigned to receive micronutrients (single dose of 200,000 IU retinyl palmitate plus 15 mg Zn/d for 8 wk) or matching placebo. Sputum was collected weekly for 8 wk for auramine staining and culture on liquid media (BACTEC MGIT 960; Becton Dickinson, Sparks, MD). Performance status, chest radiographs, and anthropometric measures were assessed at baseline and again at 8 wk.


RESULTS
The participants (n = 154) were randomly assigned to the micronutrient (n = 77) or placebo (n = 77) group. Twenty participants were HIV infected (13%), and 12 participants had an unknown HIV status (8%). No differences in time to smear or culture conversion were observed between the treatment groups by Kaplan-Meier analysis (P = 0.15 and P = 0.38, respectively; log-rank test). Log-logistic regression analysis found no significant group interaction effect in time to culture detection over the 8-wk period (P = 0.32). No significant differences in weight gain (2.3 ± 3.5 compared with 2.2 ± 2.4 kg, P = 0.68) or radiologic resolution were observed between the treatment groups.


CONCLUSIONS
Supplementation with vitamin A and zinc did not affect treatment outcomes in participants with pulmonary tuberculosis at 8 wk. This trial was registered at controlled-trials.com as ISRCTN80852505.
School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa. marianne.visser@gmail.com
Marianne E
ME
Visser
Harleen Ms
HM
Grewal
Elizabeth C
EC
Swart
Muhammad A
MA
Dhansay
Gerhard
G
Walzl
Sonja
S
Swanevelder
Carl
C
Lombard
Gary
G
Maartens
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D003300:Copper / Q000097:blood; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000188:drug therapy*; D014801:Vitamin A / Q000008:administration & dosage* / Q000097:blood; D015032:Zinc / Q000008:administration & dosage* / Q000097:blood
D014801:Vitamin A; D003300:Copper; D002097:C-Reactive Protein; D015032:Zinc