THE ROLE OF VITAMIN D SUPPLEMENTATION TO FIRST-LINE ANTI-TUBERCULOSIS TREATMENT IN TREATMENT COURSE OF PULMONARY TUBERCULOSIS
DOI:
https://doi.org/10.22159/ajpcr.2025v18i3.53739Keywords:
Tuberculosis, Vitamin D supplementation, Anti-tuberculosis treatment, Treatment courseAbstract
Objectives: The objective of the study was to study the role of Vitamin D supplementation to first-line anti-tuberculosis treatment (ATT) in the treatment course of pulmonary tuberculosis (TB).
Methods: This study was conducted on sputum acid-fast bacilli (AFB) positive outpatient department and inpatient department patients who had presented to Batra Hospital and Medical Research Centre, New Delhi. We had included 66 patients who were newly diagnosed sputum smear AFB positive. The patients were divided into two groups. Each subject signed a special consent form that was written in simple phrase. The procedure and the aim of the work were explained to all the subjects in simple language and due consent was taken.
Results: Majority of the patients in Group 1 (cases) were in age group of 51–60 years (30%) and in Group 2 (controls) were in age group of < 30 years (27%). Mean age was found to be comparable in both groups, which was 46.3±17.91 years in Group 1 (cases) and 47.46±17.27 years in Group 2 (cases). Gender ratio was also comparable in both groups with 60.61% males and 39.9% females in Group 1 (cases), and 72.73% males and 27.7 % females in Group 2 (controls). In Group 1 (cases) mean TB score was 5.82±1.01 and in Group 2 (controls) mean TB score was 5.94±1.09 (p=0.683). After 2 months mean TB score in Group 1 was 1.7±1.38 and in Group 2 was 2.94±1.82. There was a statistically significant difference in TB score between the two groups (p=0.0002).
Conclusion: In the present study, we found that the majority of the patients enrolled were males, this could have been due to less accessibility of females to medical healthcare facility due to social factors. Patients who received Vitamin D along with first-line ATT had early sputum smear conversion as compared to those who were on ATT only. Furthermore, patients who received Vitamin D with ATT had better TB score after 2 months of therapy as compared to patients on first-line ATT only. Thus, Vitamin D supplementation to first-line ATT can reduce time to sputum conversion and accelerate clinical improvement.
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References
World Health Organization: Global Tuberculosis Report. Geneva: World Health Organization; 2016. Available from: https://www.who. int/tb/publications/global_report/en
Ministry of Health and Family Welfare- Government of India. TB India Report 2018. Ministry of Health and Family Welfare. Available from: https://tbcindia.gov.in/showfile.php?lid=3314 [Last accessed on 2018 Dec 26].
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J, editors. Harrison Principles of Internal Medicine. 19th ed. New York: McGraw-Hill; 2015. p. 1102-22.
Rook GA, Steele J, Fraher L, Barker S, Karmali R, O’riordan J, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology. 1986 Jan;57(1):159-63. PMID: 3002968
Compston JE. Vitamin D deficiency: Time for action. Evidence supports routine supplementation for elderly people and others at risk. BMJ. 1998;317(7171):1466-7. doi: 10.1136/bmj.317.7171.1466, PMID: 9831568
Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266- 81. doi: 10.1056/NEJMra070553, PMID: 17634462
Rockett KA, Brookes R, Udalova I, Vidal V, Hill AV, Kwiatkowski D. 1, 25-dihydroxyvitamin D3 induces nitric oxide synthase and suppresses growth of Mycobacterium tuberculosis in a human macrophage-like cell line. Infect Immun. 1998 Nov 1;66(11):5314-21. doi: 10.1128/ IAI.66.11.5314-5321.1998, PMID: 9784538
Sly LM, Lopez M, Nauseef WM, Reiner NE. 1α,25-Dihydroxyvitamin D3-induced monocyte antimycobacterial activity is regulated by phosphatidylinositol 3-kinase and mediated by the NADPH-dependent phagocyte oxidase. J Biol Chem. 2001;276(38):35482-93. doi: 10.1074/ jbc.M102876200, PMID: 11461902
Coussens A, Timms PM, Boucher BJ, Venton TR, Ashcroft AT, Skolimowska KH, et al. 1α, 25‐dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009 Aug;127(4):539-48. doi: 10.1111/j.1365- 2567.2008.03024.x, PMID: 19178594
Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006 Mar 24;311(5768):1770-3. doi: 10.1126/ science.1123933, PMID: 16497887
Martineau AR, Wilkinson KA, Newton SM, Floto RA, Norman AW, Skolimowska K, et al. IFN-γ- and TNF-independent vitamin D-inducible human suppression of mycobacteria: The role of cathelicidin LL-37. J Immunol. 2007 Jun 1;178(11):7190-8. doi: 10.4049/jimmunol.178.11.7190, PMID: 17513768
Yuk JM, Shin DM, Lee HM, Yang CS, Jin HS, Kim KK, et al. Vitamin D3 induces autophagy in human monocytes/macrophages via cathelicidin. Cell Host Microbe. 2009 Sep 17;6(3):231-43. doi: 10.1016/j.chom.2009.08.004, PMID: 19748465
Selvaraj P, Chandra G, Jawahar MS, Rani MV, Rajeshwari DN, Narayanan PR. Regulatory role of vitamin D receptor gene variants of Bsm I, Apa I, Taq I, and Fok I polymorphisms on macrophage phagocytosis and lymphoproliferative response to Mycobacterium tuberculosis antigen in pulmonary tuberculosis. J Clin Immunol. 2004 Sep 1;24(5):523-32. doi: 10.1023/B: JOCI.0000040923.07879.31, PMID: 15359111
Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: A systematic review and meta-analysis. Int J Epidemiol. 2008 Feb 1;37(1):113-9. doi: 10.1093/ije/dym247, PMID: 18245055
Nursyam EW, Amin Z, Rumende CM. The effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculous lesion. Acta Med Indones. 2006;38(1):3-5. PMID: 16479024
Wejse C, Gomes VF, Rabna P, Gustafson P, Aaby P, Lisse IM, 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(9):843-50. doi: 10.1164/rccm.200804-567OC, PMID: 19179490
Wejse C, Gustafson P, Nielsen J, Gomes VF, Aaby P, Andersen PL, et al. TBscore: Signs and symptoms from tuberculosis patients in a low-resource setting have predictive value and may be used to assess clinical course. Scand J Infect Dis. 2008 Jan 1;40(2):111-20. doi: 10.1080/00365540701558698, PMID: 17852907
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6. doi: 10.4103/0253-7176.116232, PMID: 24049221
Deshpande RV, Rathod BS, Rahtekar PN, Bhore AD, Sharma SH, Mahale HL. Study of vitamin D levels in pulmonary tuberculosis patients at a tertiary care hospital. J Eval Med Dent. 2017 Jun 1;6(44):3424-6.
Martineau AR, Timms PM, Bothamley GH, Hanifa Y, Islam K, Claxton AP, et al. High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: A double-blind randomised controlled trial. Lancet. 2011 Jan 15;377(9761):242-50. doi: 10.1016/S0140-6736(10)61889-2, PMID: 21215445
Kota SK, Jammula S, Kota SK, Tripathy PR, Panda S, Modi KD. Effect of vitamin D supplementation in type 2 diabetes patients with pulmonary tuberculosis. Diabetes Metab Syndr. 2011 Apr 1;5(2):85-9. doi: 10.1016/j.dsx.2012.02.021, PMID: 22813409
Hassanein EG, Mohamed EE, Baess AI, EL-Sayed ET, Yossef AM. The role of supplementary vitamin D in treatment course of pulmonary tuberculosis. Egypt J Chest Dis Tuberc. 2016;65(3):629-35. doi: 10.1016/j.ejcdt.2016.03.004
Ralph AP, Waramori G, Pontororing GJ, Kenangalem E, Wiguna A, Tjitra E, et al. L-arginine and vitamin D adjunctive therapies in pulmonary tuberculosis: A randomised, double-blind, placebo-controlled trial. PLoS One. 2013 Aug 14;8(8):e70032. doi: 10.1371/ journal.pone.0070032, PMID: 23967066
Tukvadze N, Sanikidze E, Kipiani M, Hebbar G, Easley KA, Shenvi N, et al. High-dose vitamin D3 in adults with pulmonary tuberculosis: A double-blind randomized controlled trial. Am J Clin Nutr. 2015 Nov;102(5):1059- 69. doi: 10.3945/ajcn.115.113886, PMID: 26399865
Salahuddin N, Ali F, Hasan Z, Rao N, Aqeel M, Mahmood F. Vitamin D accelerates clinical recovery from tuberculosis: Results of the SUCCINCT Study [Supplementary cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin D supplementation in patients with pulmonary tuberculosis’. BMC Infect Dis. 2013 Dec;13(1):22. doi: 10.1186/1471-2334-13-22, PMID: 23331510
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Copyright (c) 2025 Dr. Shivalik Gupta1, Dr. U Maheswarchandrakantham2, Dr. Dileep Dandotiya3, Dr. D N Jha4

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