title: Vitamin D status and incidence of pulmonary tuberculosis, opportunistic infections, and wasting among HIV-infected Tanzanian adults initiating antiretroviral therapy.
abstract: BACKGROUND
  Maintaining vitamin D sufficiency may decrease the incidence of pulmonary tuberculosis and other infectious diseases. We present the first prospective study of vitamin D among human immunodeficiency virus (HIV)-infected adults receiving antiretrovirals in sub-Saharan Africa.
  
  
  METHODS
  Serum 25-hydroxyvitamin D (25(OH)D) level was assessed at antiretroviral therapy (ART) initiation for 1103 HIV-infected adults enrolled in a trial of multivitamins (not including vitamin D) in Tanzania. Participants were prospectively followed at monthly visits at which trained physicians performed a clinical examination and nurses took anthropometric measurements and assessed self-reported symptoms. Cox proportional hazards models estimated hazard ratios (HRs) of morbidity outcomes.
  
  
  RESULTS
  After multivariate adjustment, vitamin D deficiency (defined as a concentration of <20 ng/mL) had a significantly greater association with incident pulmonary tuberculosis, compared with vitamin D sufficiency (HR, 2.89; 95% confidence interval [CI], 1.31-7.41; P = .027), but no association was found for vitamin D insufficiency (defined as a concentration of 20-30 ng/mL; P = .687). Deficiency was also significantly associated with incident oral thrush (HR, 1.96; 95% CI, 1.01-3.81; P = .046), wasting (HR, 3.10; 95% CI, 1.33-7.24; P = .009), and >10% weight loss (HR, 2.10; 95% CI, 1.13-3.91; P = .019). Wasting results were robust to exclusion of individuals experiencing pulmonary tuberculosis. Vitamin D status was not associated with incident malaria, pneumonia, or anemia.
  
  
  CONCLUSIONS
  Vitamin D supplementation trials for adults receiving ART appear to be warranted.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Sudfeld
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.forename: Sheila
authors.initials: S
authors.lastname: Isanaka
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Mugusi
authors.forename: Molin
authors.initials: M
authors.lastname: Wang
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D019247:HIV Wasting Syndrome / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D013636:Tanzania / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology*; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood*; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D