Vitamin D and solar ultraviolet radiation in the risk and treatment of tuberculosis

Date

2013

Authors

Ralph, Anna P
Norval, M
Lucas, Robyn

Journal Title

Journal ISSN

Volume Title

Publisher

Lancet Publishing Group

Abstract

Improved understanding of the association between tuberculosis and vitamin D is needed to inform clinical practice. Vitamin D has both immunostimulatory and immunosuppressive effects relevant to human antimycobacterial responses. Ultraviolet radiation, the main source of vitamin D, also induces immunomodulation and could affect the relation between vitamin D and tuberculosis. Clinical trials of vitamin D supplementation in patients with tuberculosis have produced largely negative results, prompting the review of dosing regimens-an explanation for low 25-hydroxyvitamin D status in patients with active tuberculosis is also needed. The reporting of vitamin D deficiency needs to address assay inaccuracies, rising thresholds to define sufficiency, and scarce knowledge of the concentrations needed for optimum immune responses. Future research to measure the effect of the inflammatory setting on serum concentrations of 25-hydroxyvitamin D, at tuberculosis diagnosis and during recovery, could help to account for 25-hydroxyvitamin D changes in these concentrations in patients with tuberculosis. Studies into the role of vitamin D supplementation in latent tuberculosis justify clinical trials in this population, but pose methodological challenges. Vitamin D trials in patients with active tuberculosis should be done in well selected populations using adequate vitamin D doses, although such doses remain undefined.

Description

Keywords

Keywords: 25 hydroxyvitamin D; antimycobacterial agent; vitamin D; adaptive immunity; clinical practice; disease association; genetic polymorphism; human; hypothesis; immunostimulation; immunosuppressive treatment; innate immunity; observational study; priority jou

Citation

Source

The Lancet Infectious Diseases

Type

Journal article

Book Title

Entity type

Access Statement

License Rights

DOI

10.1016/S1473-3099(12)70275-X

Restricted until

2037-12-31