title: Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Outpatient clinics in Tanzania.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Mugusi
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Willy
authors.initials: W
authors.lastname: Urassa
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
keywords: Africa; HIV; Vitamin D