Calcitriol supplementation accelerates the recovery of patients with tuberculosis who have vitamin D deficiency: a randomized, single-blind, controlled clinical trial

Background This study aimed to evaluate whether calcitriol supplementation enhances CD4(+) T cell count and prognosis in patients with tuberculosis and low 25(OH)D levels. Methods This randomized controlled clinical trial enrolled treatment-naive patients with tuberculosis admitted to Zigong First People's Hospital (June 2016 to April 2017). The patients were grouped as the serum 25(OH)D >= 75 nmol/L (Normal-25(OH)D) and 25(OH)D < 75 nmol/L (Low-25(OH)D) groups. The Low-Vit-D group was randomized to the Low-25(OH)D and Low-25(OH)D-Calcitriol groups. All patients were treated with the 2HRZE/4HR regimen. The patients in the Low-25(OH)D-Calcitriol group received calcitriol 0.25 mu g bid. The main endpoints were CD4(+) T cell count during treatment, time to sputum culture conversion, time to 50% lesion absorption, and a 6-month cure rate. Results This study included 30 patients in each group. Baseline 25-(OH) D levels and CD4(+) T cell counts were higher in the Normal-25(OH)D group than in the Low-25(OH)D and Low-25(OH)D-Calcitriol groups (25(OH)D: 79.3 +/- 3.4 vs. 37.8 +/- 13.4 vs. 11.9 nmol/L, P < 0.05; 671 +/- 287 vs. 200 +/- 110 vs. 194 +/- 119 cell/mu L, P < 0.05). 25-(OH) D levels and CD4(+) T cell counts increased in the Low-25(OH)D-Calcitriol group during treatment to reach higher levels than in the Low-25(OH)D group at 1, 4, 8, and 24 weeks (all P < 0.05). Compared with the Low-25(OH)D group, the Low-25(OH)D-Calcitriol group showed shorter time to sputum culture conversion (3.2 +/- 1.4 vs. 5.9 +/- 2.5 days, P < 0.001) and time to 50% lesion absorption (7.4 +/- 1.5 vs. 10.9 +/- 4.0 days, P = 0.014) and similar to those in the Normal-25(OH)D group (3.1 +/- 1.2 and 7.3 +/- 1.5 days, respectively. The cure rate was 86.7% in the Low-25(OH)D group and 96.7% in the two other groups. Conclusions Calcitriol supplementation can elevate CD4(+) T cell levels, shorten the time to sputum culture conversion, and accelerate lesion absorption in patients with tuberculosis and 25(OH)D deficiency. Trial registration The study is registered at the Chinese Clinical Trial Registry (ChiCTR2000039832)

Automated summary

This study demonstrates that calcitriol supplementation can increase the CD4(+) T cell levels, shorten the time to sputum culture conversion, and accelerate lesion absorption in patients with tuberculosis. It has the potential to improve the prognosis of tuberculosis patients.