Vitamin D as supplementary treatment for tuberculosis: a double-blind, randomized, placebo-controlled trial.

Infectious Disease Research Unit, Aarhus University Hospital, Skejby, Brendstrupgaardsvej, 8200 Aarhus N, Denmark.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 11.99). 02/2009; 179(9):843-50. DOI: 10.1164/rccm.200804-567OC
Source: PubMed

ABSTRACT Vitamin D has been shown to be involved in the host immune response toward Mycobacterium tuberculosis.
To test whether vitamin D supplementation of patients with tuberculosis (TB) improved clinical outcome and reduced mortality.
We conducted a randomized, double-blind, placebo-controlled trial in TB clinics at a demographic surveillance site in Guinea-Bissau. We included 365 adult patients with TB starting antituberculosis treatment; 281 completed the 12-month follow-up. The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again 5 and 8 months after the start of treatment.
The primary outcome was reduction in a clinical severity score (TBscore) for all patients with pulmonary TB. The secondary outcome was 12-month mortality. No serious adverse effects were reported; mild hypercalcemia was rare and present in both arms. Reduction in TBscore and sputum smear conversion rates did not differ among patients treated with vitamin D or placebo. Overall mortality was 15% (54 of 365) at 1 year of follow-up and similar in both arms (30 of 187 for vitamin D treated and 24 of 178 for placebo; relative risk, 1.19 [0.58-1.95]). HIV infection was seen in 36% (131 of 359): 21% (76 of 359) HIV-1, 10% (36 of 359) HIV-2, and 5% (19 of 357) HIV-1+2.
Vitamin D does not improve clinical outcome among patients with TB and the trial showed no overall effect on mortality in patients with TB; it is possible that the dose used was insufficient. Clinical trial registered with (ISRCTN35212132).


Available from: Christian Wejse, Mar 06, 2014
  • Article: In reply.
    Mayo Clinic Proceedings 08/2012; 87(8):808-9. DOI:10.1016/j.mayocp.2012.04.012 · 5.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Vitamin D receptor (VDR) knockout (KO) mice had fewer Citrobacter rodentium in the feces than wild-type (WT) mice and the kinetics of clearance was faster in VDR KO than WT mice. VDR KO mice had more interleukin-22 (IL-22)-producing innate lymphoid cells (ILCs) and more antibacterial peptides than WT mice. The increased ILCs in the VDR KO mice was a cell-autonomous effect of VDR deficiency on ILC frequencies. Bone marrow (BM) transplantation from VDR KO mice into WT resulted in higher ILCs and colonization resistance of the WT mice. Disruption of the gut microbiota using antibiotics in VDR KO mice reversed colonization resistance to C. rodentium infection. Confirming the role of the microbiota in the colonization resistance of VDR KO mice, transfer of the VDR KO microbiota to WT germ-free mice resulted in colonization resistance. Once colonization resistance was overcome, VDR KO mice had increased susceptibility to C. rodentium. VDR expression is a regulator of ILC frequencies, IL-22, dysbiosis, and C. rodentium susceptibility.Mucosal Immunology advance online publication, 15 October 2014; doi:10.1038/mi.2014.94.
    Mucosal Immunology 10/2014; 8(3). DOI:10.1038/mi.2014.94 · 7.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Observational studies have linked vitamin D status and infectious disease. This association is supported by the presence of the vitamin D receptor and CYP27B1 in immune cells. This review aims to consolidate data from clinical trials that used vitamin D for the treatment or prevention of infectious disease.
    The American Journal of the Medical Sciences 10/2014; DOI:10.1097/MAJ.0000000000000360 · 1.52 Impact Factor