title: Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes.
abstract: METHODS
  Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment.
  
  
  OBJECTIVE
  To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment.
  
  
  METHODS
  A prospective longitudinal cohort study.
  
  
  RESULTS
  The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART.
  
  
  CONCLUSIONS
  Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sloan
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: H C
authors.initials: HC
authors.lastname: Mwandumba
authors.affiliation: Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Kamdolozi
authors.affiliation: Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: D
authors.initials: D
authors.lastname: Shani
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: B
authors.initials: B
authors.lastname: Chisale
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dutton
authors.affiliation: Department of Pharmacology, University of Liverpool, Liverpool, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Khoo
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: T J
authors.initials: TJ
authors.lastname: Allain
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, UK.
authors.forename: G R
authors.initials: GR
authors.lastname: Davies
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000188:drug therapy*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000453:epidemiology* / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D