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- Title
Vitamin D Status and Incidence of Pulmonary Tuberculosis, Opportunistic Infections, and Wasting Among HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy.
- Authors
Sudfeld, Christopher R.; Giovannucci, Edward L.; Isanaka, Sheila; Aboud, Said; Mugusi, Ferdinand M.; Wang, Molin; Chalamilla, Guerino; Fawzi, Wafaie W.
- 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.
- Subjects
TANZANIA; VITAMIN D; TUBERCULOSIS prevention; PREVENTION of communicable diseases; HIV infections; MALARIA; PNEUMONIA
- Publication
Journal of Infectious Diseases, 2013, Vol 207, Issue 3, p378
- ISSN
0022-1899
- Publication type
Article
- DOI
10.1093/infdis/jis693