Proceedings of the Nutrition Society

A meeting of the Nutrition Society hosted by the Irish Section jointly with the American Society for Nutrition, University College Cork, Republic of Ireland.15–17 June 2011,

70th Anniversary Conference on ‘Vitamins in early development and healthy aging: impact on infectious and chronic disease’

Symposium 4: Vitamins, infectious and chronic disease during adulthood and aging

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

Adrian R. Martineaua1 c1

a1 Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London E1 2AB, UK

Abstract

Tuberculosis (TB) is a major cause of mortality, responsible for 1·68 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.

(Online publication November 29 2011)

Correspondence

c1 Corresponding author: Dr Adrian Martineau, fax +44 207 882 2552, email a.martineau@qmul.ac.uk