Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory for HIV/AIDS Research, Beijing, China.
Front Public Health. 2024 Feb 14;12:1344024. doi: 10.3389/fpubh.2024.1344024. eCollection 2024.
Vitamin D deficiency (VDD) is a worldwide disease. VDD is also associated with an increased risk of HIV-related comorbidities and mortality, and patients have a tendency to develop active tuberculosis compared to those with latent tuberculosis infection. Vitamin D supplementation may modulate HIV replication, improve TB inflammation and reduce progression of HIV-TB co-infection.
We meta-analyzed individual participant data from cohort studies, cross-sectional study, and RCTs of vitamin D in HIV group, TB group, and HIV-TB group. The primary outcomes were differences in vitamin D level and VDD prevalence between three groups, the secondary outcomes were CD4 count, HIV viral load, time to sputum smear conversion, time to culture conversion, relapse, morality, and TB score.
For vitamin D levels, the overall mean difference (MD) between HIV group and TB group was -0.21 (95% CI, -20.80-20.38; = 0.9, = 84%), HIV group and HIV-TB group was 0.87 (95% CI, -11.45-13.20; = 0.89, = 87%), and TB group and HIV-TB group was 1.17 (95% CI, -5.21-7.55; = 0.72, = 85%). For vitamin D deficiency prevalence, the overall odds ratio (OR) for HIV group versus TB group was 1.23 (95% CI, 0.46-3.31; = 0.68; = 70%), HIV group versus HIV-TB group was 1.53 (95% CI, 1.03-2.29; = 0.04; = 0%), and TB group versus HIV-TB group was 0.85 (95% CI, 0.61-1.20; = 0.36; = 22%). In HIV-TB group, the overall OR for vitamin D group versus placebo group was 0.78 (95% CI, 0.34-1.67; = 0.52; = 60%).
Our findings indicated that there were no variations in vitamin D levels between three groups. The prevalence of vitamin D deficiency was higher in the HIV-TB group than in the HIV group. Additionally, the administration of vitamin D supplements did not have obvious impact on CD4 count and viral load. Likewise, vitamin D had no effect on time to sputum smear conversion, time to culture conversion, relapse, 12-month morality, and TB score.
维生素 D 缺乏症（VDD）是一种全球性疾病。VDD 还与 HIV 相关合并症和死亡率的增加风险相关，与潜伏性结核感染患者相比，患者更容易发展为活动性结核病。维生素 D 补充可能会调节 HIV 复制，改善结核病炎症，并减少 HIV-TB 合并感染的进展。
我们对 HIV 组、TB 组和 HIV-TB 组的队列研究、横断面研究和 RCT 中的个体参与者数据进行了荟萃分析。主要结局是三组间维生素 D 水平和 VDD 患病率的差异，次要结局是 CD4 计数、HIV 病毒载量、痰涂片转阴时间、培养转阴时间、复发、死亡率和结核病评分。
对于维生素 D 水平，HIV 组与 TB 组之间的总体平均差异（MD）为-0.21（95%CI，-20.80-20.38； = 0.9， = 84%），HIV 组与 HIV-TB 组之间为 0.87（95%CI，-11.45-13.20； = 0.89， = 87%），TB 组与 HIV-TB 组之间为 1.17（95%CI，-5.21-7.55； = 0.72， = 85%）。对于维生素 D 缺乏症患病率，HIV 组与 TB 组之间的总体比值比（OR）为 1.23（95%CI，0.46-3.31； = 0.68； = 70%），HIV 组与 HIV-TB 组之间为 1.53（95%CI，1.03-2.29； = 0.04； = 0%），TB 组与 HIV-TB 组之间为 0.85（95%CI，0.61-1.20； = 0.36； = 22%）。在 HIV-TB 组中，维生素 D 组与安慰剂组之间的总体 OR 为 0.78（95%CI，0.34-1.67； = 0.52； = 60%）。
我们的研究结果表明，三组间的维生素 D 水平没有变化。与 HIV 组相比，HIV-TB 组的维生素 D 缺乏症患病率更高。此外，给予维生素 D 补充剂对 CD4 计数和病毒载量没有明显影响。同样，维生素 D 对痰涂片转阴时间、培养转阴时间、复发、12 个月死亡率和结核病评分均无影响。
