Musarurwa C, et al. - Researchers determined the prevalence, covariates of vitamin D deficiency (VDD) and risk of pulmonary tuberculosis (PTB) among human immunodeficiency virus (HIV)- infected hospitalized patients with and without PTB. Among hospitalised HIV-infected patients in the present study, a link was observed between higher serum 25-hydroxyvitamin D [25(OH) D] concentrations and active PTB and tuberculosis (TB)-related mortality. This finding is at variance with the commonly reported relation of hypovitaminosis and susceptibility to TB.

Methods

• This comparative cross-sectional study included 145 HIV⁺/pulmonary TB⁺ (PTB) and 139 HIV⁺/PTB^- hospitalised patients.
• From participants enrolled in a randomised controlled trial (RCT) conducted to investigate the impact of using a point-of-care urine lipoarabinomannan strip test for TB diagnosis, archived serum specimens were selected using stratified random sampling.
• Sputum smear microscopy, culture or GeneXpert MTB/RIF were used to corroborate PTB status.
• Prior to commencement of anti-TB treatment, competitive chemiluminescent immunoassay was used to assay serum 25-hydroxyvitamin D [25(OH) D] concentrations.
• Researchers determined the impact of VD status on duration of hospital stay and patient outcomes on follow up at 8 weeks.
• Using Mann-Whitney test, median serum 25(OH) D concentrations were compared.
• They assessed covariates of serum VD status using logistic regression analysis.

Results

• The reported overall VDD prevalence in the cohort was 40.9% (95% CI: 35.1–46.8).
• Significantly higher median serum 25(OH)D concentrations were detected in HIV⁺/PTB⁺ group (25.3 ng/ml, IQR:18.0–33.7) vs the HIV⁺/PTB^- group (20.4 ng/ml, IQR:14.6–26.9), p=0.0003.
• Relative to those with serum 25(OH) D concentrations + (odds ratio (OR) 1.91; 95% CI 1.1–3.2).
• PTB-related death was found to be related to higher odds of having 25(OH) D levels≥30 ng/ml.
• No association of age, gender, CD4⁺ count, combination antiretroviral therapy (cART) status, efavirenz based cART regimen and length of hospital stay with vitamin D status was found.