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Proc Nutr Soc. 2012 Feb;71(1):84-9. doi: 10.1017/S0029665111003326. Epub 2011 Nov 29.

Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis.

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  • Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London E1 2AB, UK. a.martineau@qmul.ac.uk

Abstract

Tuberculosis (TB) is a major cause of mortality, responsible for 1ยท68 million deaths worldwide in 2009. The global prevalence of latent Mycobacterium tuberculosis infection is estimated to be 32%, and this carries a 5-20% lifetime risk of reactivation disease. The emergence of drug-resistant organisms necessitates the development of new agents to enhance the response to antimicrobial therapy for active TB. Vitamin D was used to treat TB in the pre-antibiotic era, and its active metabolite, 1,25-dihydoxyvitamin D, has long been known to enhance the immune response to mycobacteria in vitro. Vitamin D deficiency is common in patients with active TB, and several clinical trials have evaluated the role of adjunctive vitamin D supplementation in its treatment. Results of these studies are conflicting, reflecting variation between studies in baseline vitamin D status of participants, dosing regimens and outcome measures. Vitamin D deficiency is also recognised to be highly prevalent among people with latent M. tuberculosis infection in both high- and low-burden settings, and there is a wealth of observational epidemiological evidence linking vitamin D deficiency with increased risk of reactivation disease. Randomised controlled trials of vitamin D supplementation for the prevention of active TB have yet to be performed, however. The conduct of such trials is a research priority, given the safety and low cost of vitamin D supplementation, and the potentially huge public health consequences of positive results.

PMID:
22123447
[PubMed - indexed for MEDLINE]
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