Hypovitaminosis D Is Common among Pulmonary Tuberculosis Patients in Tanzania but Is Not Explained by the Acute Phase Response

Friis, Henrik; Range, Nyagosya; Pedersen, Marianne L.; Mølgaard, Christian; Changalucha, John; Krarup, Henrik; Magnussen, Pascal; Søborg, Christian; Andersen, Anita Sylvest

doi:10.3945/jn.108.094979

Cited by 59 publications

(74 citation statements)

References 34 publications

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“…The need for such trials is pressing, given the very high incidence of TB in HIV-infected adults in Cape Town and the high prevalence of vitamin D deficiency that we report in this group, which is significantly higher than has been reported in tropical Africa (14)(15)(16)(17). To our knowledge, the prevalence of vitamin D deficiency among people of Nguni descent living in Cape Town has not previously been investigated.…”

Section: Discussioncontrasting

confidence: 53%

“…The prevalence of profound vitamin D deficiency among TB patients in tropical Africa is much lower than in Europe [reported in 0.3-11.2% of patients with TB in tropical Africa (14)(15)(16)(17) vs. 64-84% of patients with TB in London (18)(19)(20)]. The prevalence of vitamin D deficiency in TB patients with and without HIV infection in subtropical Africa has not previously been reported.…”

Section: Vitamin D Deficiency (Serum 25-hydroxyvitamin D [25(oh)d] <50mentioning

confidence: 95%

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Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa

Martineau

Nhamoyebonde

Oni

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

185

181

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Vitamin D deficiency is associated with susceptibility to tuberculosis (TB) in HIV-uninfected people in Europe, but it is not known whether such an association exists among HIV-infected people in subtropical Africa. We conducted a cross-sectional study to determine whether vitamin D deficiency was associated with susceptibility to active TB in and HIV-infected (n = 174) black Africans in Cape Town, South Africa. We also investigated whether there was evidence of seasonal variation in vitamin D status and TB notifications in this setting over an 8-y period.nmol/L) was present in 232 (62.7%) of 370 participants and was associated with active TB in both HIV-uninfected (odds ratio = 5.2, 95% confidence interval: 2.8-9.7; P < 0.001) and HIV-infected (odds ratio = 5.6, 95% confidence interval: 2.7-11.6; P < 0.001) people. We have previously reported that vitamin D deficiency is associated with susceptibility to TB in London and that this association is modified by polymorphisms in the vitamin D receptor and vitamin D binding protein (8,9). We have also shown that in vivo vitamin D supplementation enhances immunity to mycobacteria both in healthy people (10) and in a genetically defined subgroup of patients with active TB (11). Reports of seasonal variation in the prevalence of vitamin D deficiency (12) and TB incidence (13) in the United Kingdom provide further evidence that low vitamin D status may compromise antimycobacterial immunity in this setting.The prevalence of profound vitamin D deficiency among TB patients in tropical Africa is much lower than in Europe [reported in 0.3-11.2% of patients with TB in tropical Africa (14-17) vs. 64-84% of patients with TB in ]. The prevalence of vitamin D deficiency in TB patients with and without HIV infection in subtropical Africa has not previously been reported. There is particularly good reason to investigate this question in Cape Town, South Africa, because TB incidence in Cape Town is higher than elsewhere in South Africa (21) and the ability of sunlight to synthesize vitamin D is compromised during the winter in Cape Town (latitude 33°south) but not in Johannesburg (latitude 26°south) (22). We therefore conducted an observational study to determine whether vitamin D deficiency is associated with susceptibility to active TB in HIVinfected and HIV-uninfected adults in Cape Town and to investigate whether there is evidence of seasonal variation in vitamin D status and TB notifications in this setting.

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Section: Discussioncontrasting

confidence: 53%

Section: Vitamin D Deficiency (Serum 25-hydroxyvitamin D [25(oh)d] <50mentioning

confidence: 95%

Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa

Martineau

Nhamoyebonde

Oni

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

185

181

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“…In fact, we were surprised that almost 40% of the women in our cohort had 25-hydroxyvitamin D levels of !32 ng/mL (80 nmol/L). However, similar results were observed among a cohort of patients with tuberculosis in Tanzania by another group of investigators [4]. Therefore, we may expect to find vitamin D levels that are closer to those observed in our study in urban settings in tropical countries, and the levels in more temperate climates may be closer to those found in Pittsburgh, Pennsylvania.…”

supporting

confidence: 91%

Reply to Equils and Hewison

Mehta

Fawzi

2010

J INFECT DIS

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To the Editor-We read with great interest the letter by Equils and Hewison [1] in reference to our article on vitamin D and perinatal outcomes, including mother-tochild transmission of human immunodeficiency virus (HIV), and child mortality [2].The authors noted that the women in our cohort had far higher levels of vitamin D than women in a study in the United States had [3]. However, Tanzania, the setting of our study, is only 6Њ south of the equator, and sunlight is in abundance throughout the year. In fact, we were surprised that almost 40% of the women in our cohort had 25-hydroxyvitamin D levels of !32 ng/mL (80 nmol/L). However, similar results were observed among a cohort of patients with tuberculosis in Tanzania by another group of investigators [4]. Therefore, we may expect to find vitamin D levels that are closer to those observed in our study in urban settings in tropical countries, and the levels in more temperate climates may be closer to those found in Pittsburgh, Pennsylvania.We agree with the authors that there is increasing evidence to support the biological plausibility for a role of vitamin D in enhancing placental immunity and the immune system of the newborn. It will be important to examine the safety and efficacy of vitamin D supplementation among pregnant women in relation to the incidence and severity of HIV infection, tuberculosis, and other infections among their offspring, particularly in resource-limited settings. References 1. Equils O, Hewison M. A role for vitamin D in placental immunology. J Infect Dis 2010; 201(12):1950-1951 (in this issue). 2. Mehta S, Hunter DJ, Mugusi FM, et al. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania.

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“…A cross sectional study was conducted among pulmonary tuberculosis (PTB) patients in Mwanza, Tanzania to identify the predictors of their vitamin D status. The authors deduced that serum 25(OH)D is a valid measure of vitamin D status during the acute phase response and that the lower concentrations in PTB+ patients may reflect increased utilization of vitamin D [49]. A study by Gibney confirms the strong association between VDD and Latent Tuberculosis Infection (LTBI) in African immigrants in Melbourne [50].…”

Section: Vitamin D Deficiency and Tbsupporting

confidence: 51%

The potential role of vitamin D for prevention and treatment of tuberculosis and infectious diseases

Dini

Bianchi

2012

Annali Dell'Istituto Superiore Di Sanità

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Abstract.Introduction.Vitamin D deficiency (VDD) is a common condition among several populations in the world. VDD is associated with higher incidence of immune system disorders and faster progression of some infectious diseases. Vitamin D is known to be of physiological importance, it is considered an essential micronutrient for the bone health and plays a beneficial role in the prevention and/or treatment of a number of chronic diseases. Vitamin D has a complex action on the immune system. Results. Evidence that vitamin D protects against tuberculosis has been supported by in vitro, epidemiological and some preliminary clinical studies. Vitamin D has a potential effect on HIV (human immunodeficiency virus) and plays a crucial role in the defence against respiratory infections. Conclusions. Vitamin D supplementation could be a low-cost, practical method to protect groups of people with high incidence of those diseases. Public health education should stress the need for adequate dietary intake of vitamin D in those vulnerable groups.Key words: VDD, Vitamin D deficiency, tuberculosis, HIV, respiratory infections. Riassunto (Il ruolo potenziale della vitamina D nella prevenzione e terapia della tubercolosi e delle malattie infettive).Introduzione. La carenza di vitamina D è una condizione comune in numerosi gruppi di popolazione nel mondo. Essa risulta associata a un'elevata incidenza dei disturbi del sistema immunitario e a una più veloce progressione di alcune malattie infettive. Oltre ad essere un micronutriente essenziale per la salute dell'apparato scheletrico, la vitamina D riveste un ruolo importante nei processi fisiologici e nella prevenzione e/o terapia di numerose patologie croniche. Essa svolge un'azione complessa sul sistema immunitario. Risultati. La dimostrazione che la vitamina D protegge contro la tubercolosi è stata supportata da studi in vitro, epidemiologici e da alcuni dati clinici preliminari. La vitamina D ha un effetto potenziale sull'HIV (sindrome da immunodeficienza acquisita) e svolge un ruolo fondamentale nelle infezioni respiratorie. Conclusioni. La somministrazione di vitamina D può essere un metodo pratico, a basso costo per proteggere gruppi specifici di popolazione con elevata incidenza delle suddette malattie. L'educazione sanitaria pubblica dovrebbe mettere in risalto la necessità di una adeguata assunzione di vitamina D in tutti i gruppi vulnerabili.Parole chiave: carenza di vitamina D, tubercolosi, HIV, infezioni respiratorie.

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Hypovitaminosis D Is Common among Pulmonary Tuberculosis Patients in Tanzania but Is Not Explained by the Acute Phase Response

Cited by 59 publications

References 34 publications

Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa

Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa

Reply to Equils and Hewison

The potential role of vitamin D for prevention and treatment of tuberculosis and infectious diseases

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