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Vitamin D and TB Outcome

In a randomized, double-blind study conducted in Guinea-Bissau, 300,000 IU of cholecalciferol had no effect on clinical outcome.

Vitamin D metabolites have been shown to induce macrophage activity against Mycobacterium tuberculosis in vitro, and supplementation was used to treat TB during the preantibiotic era. In addition, two recent small studies have suggested that vitamin D supplementation provides clinical benefit in patients with active TB.

To examine whether such supplementation might improve clinical response to treatment, researchers performed a randomized, double-blind, placebo-controlled study in Guinea-Bissau among 365 adults with active pulmonary TB who were initiating antituberculosis therapy. Among these, 281 had follow-up at 12 months. The treatment group received 100,000 IU of cholecalciferol on enrollment and again at 5 and 8 months.

No serious adverse effects of vitamin D therapy were seen, and no cases of hypercalcemia were identified at 8 months. Clinical outcomes, as measured with the TBscore (which incorporates symptoms and signs of active TB), were similar between the treatment and placebo groups, as were rates of mortality and of conversion to smear negative. TBscores at the end of treatment were significantly lower for patients with normal vitamin D status at baseline than for those with vitamin D insufficiency, regardless of supplementation. However, vitamin D supplementation appeared to result in a more rapid TBscore reduction among HIV-negative patients than among HIV-positive ones. Finally, although serum vitamin D levels overall were higher at 8 months than at baseline, increases were similar between groups.

Comment: This relatively large, well-designed study demonstrated no overall clinical benefit of vitamin D supplementation for active TB in an African cohort. However, given the trends for improvement in patients without HIV infection and the suggestion of worse clinical outcomes in those with vitamin D insufficiency, supplementation studies will certainly continue.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases May 20, 2009

Citation(s):

Wejse C et al. Vitamin D as supplementary treatment for tuberculosis: A double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 2009 May 1; 179:843.

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Reader Remarks:

Review and add to remarks on this article

• vitamin D and tuberculosis
  carolyn V Brown, private practice medicine, 22 May 2009 2:12 PM EST
  This is really very interesting. I am interested to know if Vitamin D has been studied in patients with positive... [more]
• Hardly a large when divided by the number of days
  Dwight Hooper, retired, 29 May 2009 2:24 PM EST
  During the autumn and winter months I take 8000 IU of vitamin D3 per day. The only side effect apparent... [more]

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