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- Title
Impact of Vitamin A Deficiency on Tuberculosis Progression.
- Authors
Podell, Brendan K; Aibana, Omowunmi; Huang, Chuan-Chin; DiLisio, James E; Harris, Macallister C; Ackart, David F; Armann, Kody; Grover, Alexander; Severe, Patrice; Juste, Marc Antoine Jean; Dupnik, Kathryn; Basaraba, Randall J; Murray, Megan B
- Abstract
Background Although previous studies have shown that vitamin A deficiency is associated with incident tuberculosis (TB) disease, the direction of the association has not been established. We investigated the impact of vitamin A deficiency on TB disease progression. Methods We conducted a longitudinal cohort study nested within a randomized clinical trial among HIV-infected patients in Haiti. We compared serial vitamin A levels in individuals who developed TB disease to controls matched on age, gender, follow-up time, and time to antiretroviral therapy initiation. We also evaluated histopathology, bacterial load, and immune outcomes in TB infection in a guinea pig model of dietary vitamin A deficiency. Results Among 773 participants, 96 developed incident TB during follow-up, 62.5% (60) of whom had stored serum samples obtained 90–365 days before TB diagnosis. In age- and sex- adjusted and multivariate analyses, respectively, incident TB cases were 3.99 times (95% confidence interval [CI], 2.41 to 6.60) and 3.59 times (95% CI, 2.05 to 6.29) more likely to have been vitamin A deficient than matched controls. Vitamin A–deficient guinea pigs manifested more extensive pulmonary pathology, atypical granuloma morphology, and increased bacterial growth after experimental TB infection. Reintroduction of dietary vitamin A to deficient guinea pigs after established TB disease successfully abrogated severe disease manifestations and altered cellular immune profiles. Conclusions Human and animal studies support the role of baseline vitamin A deficiency as a determinant of future TB disease progression.
- Subjects
GUINEA; HAITI; TUBERCULOSIS risk factors; DISEASE progression; CONFIDENCE intervals; MULTIVARIATE analysis; ANIMAL experimentation; LUNGS; CASE-control method; VITAMIN A deficiency; DIETARY supplements; TUBERCULOSIS; MYCOBACTERIUM tuberculosis; MALNUTRITION; LONGITUDINAL method; ANIMALS; DISEASE complications
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 12, p2178
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac326