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2500-12-31
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VITAMIN A AND D DEFICIENCIES ASSOCIATED WITH INCIDENT TUBERCULOSIS IN HIV-INFECTED PATIENTS INITIATING ANTIRETROVIRAL THERAPY IN MULTINATIONAL CASE-COHORT STUDY
Tuberculosis
Case-cohort study
HIV
Antiretroviral treatment
Resource-limited settings
The NWCS319 and ACTG 5175 study team, ver em Notas Lista de Autores | Date Issued:
2017
Affilliation
Múltipla - ver em Notas
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.
Keywords
MicronutrientsTuberculosis
Case-cohort study
HIV
Antiretroviral treatment
Resource-limited settings
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