Description | Mark W. Tenforde, MD, MPH,* Ashish Yadav, MBBS, MD, MPH,† David W. Dowdy, MD, PhD, Nikhil Gupte, PhD,§ Rupak Shivakoti, PhD, MSPH,§ Wei-Teng Yang, MD, MPH,k Noluthando Mwelase, MBChB, Cecilia Kanyama, MD,# Sandy Pillay, MBChB,** Wadzanai Samaneka, MBChB, MSc,†† Breno Santos, MD,‡‡ Selvamuthu Poongulali, MBBS,§§ Srikanth Tripathy, MBBS,kk Cynthia Riviere, MD, Sima Berendes, MD, MPH,##***
Javier R. Lama, MD, MPH,††† Sandra W. Cardoso, MD,‡‡‡ Patcharaphan Sugandhavesa, MD,§§§ Rarul Christian, DrPH, MSc,† Richard D. Semba, MD, MPH,kkk Thomas B. Campbell, MD, and
Amita Gupta, MD, MHS,†§ the NWCS319 and ACTG 5175 study team
From the *Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Departments of †International Health; ‡Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; kDepartment of Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT; Department of Medicine, University of Witwatersrand, Johannesburg, South Africa; #UNC Lilongwe, Lilongwe, Malawi; **Durban International Clinical Research Site, Durban University of Technology, Durban, South Africa; ††University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe; ‡‡Hospital
Nossa Senhora de Conceição, Porto Alegre, Brazil; §§YR Gaitonde Centre for AIDS Research and Education, Chennai, India; kkNational AIDS Research Institute, Pune, India; Les Centres GHESKIO, Port-Au-Prince, Haiti; ##Malawi College of Medicine, Johns Hopkins University Research Project, Blantyre, Malawi; ***Liverpool School of Tropical Medicine, Liverpool, United Kingdom; †††Asociacion Civil Impacta Salud y Educacion, Lima, Peru; ‡‡‡STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; §§§Research Institute for Health Sciences, Chiang Mai, Thailand; kkkDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD; and Division of Infectious
Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO. | pt_BR |
Abstract | Introduction: Numerous micronutrients have immunomodulatory
roles that may influence risk of tuberculosis (TB), but the association
between baseline micronutrient deficiencies and incident TB after
antiretroviral therapy (ART) initiation in HIV-infected individuals is
not well characterized. Methods: We conducted a case-cohort study (n = 332) within a randomized trial comparing 3 ART regimens in 1571 HIV
treatment-naive adults from 9 countries. A subcohort of 30 patients
was randomly selected from each country (n = 270). Cases (n = 77;
main cohort = 62, random subcohort = 15) included patients
diagnosed with TB by 96 weeks post-ART initiation. We determined
pretreatment concentrations of vitamin A, carotenoids, vitamin B6,
vitamin B12, vitamin D, vitamin E, and selenium. We measured
associations between pretreatment micronutrient deficiencies and
incident TB using Breslow-weighted Cox regression models.
Results: Median pretreatment CD4+ T-cell count was 170 cells/
mm3; 47.3% were women; and 53.6% Black. In multivariable
models after adjusting for age, sex, country, treatment arm, previous
TB, baseline CD4 count, HIV viral load, body mass index, and Creactive
protein, pretreatment deficiency in vitamin A (adjusted hazard ratio, aHR 5.33, 95% confidence interval, CI: 1.54 to 18.43) and vitamin D (aHR 3.66, 95% CI: 1.16 to 11.51) were associated with TB post-ART.
Conclusions: In a diverse cohort of HIV-infected adults from
predominantly low- and middle-income countries, deficiencies in
vitamin A and vitamin D at ART initiation were independently
associated with increased risk of incident TB in the ensuing 96
weeks. Vitamin A and D may be important modifiable risk factors
for TB in high-risk HIV-infected patients starting ART in resourcelimited
highly-TB-endemic settings. | pt_BR |