title: Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis.
abstract: Tuberculosis (TB) is a major cause of mortality, responsible for 1·68 million deaths worldwide in 2009. The global prevalence of latent Mycobacterium tuberculosis infection is estimated to be 32%, and this carries a 5-20% lifetime risk of reactivation disease. The emergence of drug-resistant organisms necessitates the development of new agents to enhance the response to antimicrobial therapy for active TB. Vitamin D was used to treat TB in the pre-antibiotic era, and its active metabolite, 1,25-dihydoxyvitamin D, has long been known to enhance the immune response to mycobacteria in vitro. Vitamin D deficiency is common in patients with active TB, and several clinical trials have evaluated the role of adjunctive vitamin D supplementation in its treatment. Results of these studies are conflicting, reflecting variation between studies in baseline vitamin D status of participants, dosing regimens and outcome measures. Vitamin D deficiency is also recognised to be highly prevalent among people with latent M. tuberculosis infection in both high- and low-burden settings, and there is a wealth of observational epidemiological evidence linking vitamin D deficiency with increased risk of reactivation disease. Randomised controlled trials of vitamin D supplementation for the prevention of active TB have yet to be performed, however. The conduct of such trials is a research priority, given the safety and low cost of vitamin D supplementation, and the potentially huge public health consequences of positive results.
authors: Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London E1 2AB, UK. a.martineau@qmul.ac.uk
authors: Adrian R
authors: AR
authors: Martineau
mesh_terms: D019587:Dietary Supplements; D004351:Drug Resistance; D049670:History, 17th Century; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007109:Immunity / Q000187:drug effects; D009169:Mycobacterium tuberculosis; D055502:Secondary Prevention; D014376:Tuberculosis / Q000188:drug therapy / Q000266:history / Q000517:prevention & control*; D014807:Vitamin D / Q000494:pharmacology / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000266:history
chemical_list: D014807:Vitamin D