vit d deficiency in malawi

8/17/2019 Vit D Deficiency in Malawi

1/10

INT J TUBERC LUNG DIS 19(8):904–911

Q 2015 Sloan e al!

"#:$$%&!%o'! o$10!5588$'*l%!15!00+1

,'a-'n D %e.'/'en/ 'n ala'an a%3l '" #3l-ona

3e/3lo': '6 .a/o an% ea-en o3/o-e

D! J! Sloan7;< =! C! an%3-a7;< ! >a-%olo?'7; D! S"an'7; B! C"'ale7 J! D3on7@

S! =! >"oo7 T! J! Alla'n7 E F H R D S : ea-en .a'l3e ela#e eaonal'E=I, an'eo'al "ea#

TUBERCULHSIS (TB) e-a'n a -a*o #3l'/ "eal"

#ole- 'n ala'! In 2017 15K /ae ee no'.'e%

#e 100 000 #o#3la'on7 an% 5K o. TB #a'en

ee "3-an '--3no%e.'/'en/ '3 (=I,) /oG

'n.e/e%!1 De#'e "e /on'en '-#le-ena'on o.

ol% =eal" Han'?a'on (=H) a##oe% ea

-en7 3//e.3l o3/o-e .o- "e ala'an

Na'onal T3e/3lo' Conol oa--e (NT)"ae e-a'ne% a O80 .o "e la %e/a%e!172 R'6

.a/o /on'3'n o #oo o3/o-e .o 'n%''%3al

#a'en7 an% ae'e o a-el'oae "ee '46

.a/o7 "ae no e een '%en'.'e%!

e'o3 o6 "a "on "a 'a-'n D %e.'/'en/

' -oe /o--on 'n ala'an a%3l '" TB "an 'n

"e eneal "o#'al #o#3la'on!27 T"e -o a/'e

'a-'n D -eaol'e ' 1725 "%o&/"ole/al/'.eol

(1725H=D)7 an '--3nolo'/all a/'e "o-one

"a '-3lae an'-/oa/e'al a/'' 'n 'o!4–9

Al"o3" /l'n'/al 'al "ae no "on '-#oe%

/l'n'/al o3/o-e "en an%a% an'3e/3lo'

ea-en ' a3-ene% '" oal 'a-'n D710–12

ae e3- leel o. 'a-'n D .o a /l'n'/all

'n'.'/an e..e/ ae 3n6non7 an% o-e eea/"e

a%o/ae alena'e %o'n ae'e o %e/'e

ene.' .o #a'/3la #a'en o3#!10 A 'nle 3%

.o- Tan?an'a e#oe% "a lo ael'ne e3-'a-'n D /on/ena'on ee ao/'ae% '" #oo

/l'n'/al o3/o-e!1

P3"e-oe7 o-e /o-#onen o. an'3e/3loG

' ea-en an% an'eo'al "ea# (ART) -a

#"a-a/olo'/all loe e3- /on/ena'on o.

3e.3l 'a-'n D -eaol'e! ,'a-'n D ' n"eG

'e% 'n "e 6'n a.e eo3e o 3nl'" o

/on3-e% 'n "e %'e7 "en /onee% e3en'al

"%o&la'on 'no 25(H=)D an% 1725(H=)D! Ion'G

a?'% (IN=) 'n"'' o" "%o&la'on e#714 "'le

Coe#on%en/e o: Dee6 J Sloan7 L'e#ool S/"ool o. To#'/al e%'/'ne7 e-o6e la/e7 L'e#ool L 5QA7 U>! Tel:( R44) 151 +05 9+! e-a'l: Dee6!Sloanl-e%!a/!36

A'/le 3-'e% 22 Jan3a 2015! P'nal e'on a//e#e% 1+ a/" 2015!

http://dx.doi.org/10.5588/http://dx.doi.org/10.5588/http://dx.doi.org/10.5588/http://dx.doi.org/10.5588/http://dx.doi.org/10.5588/http://dx.doi.org/10.5588/mailto:[email protected]:[email protected]://dx.doi.org/10.5588/http://dx.doi.org/10.5588/


2/10

,'a-'n D 'n TB: '6 .a/o an% o3/o-e 905

'.a-#'/'n (R) 'n%3/e alena'e en?-e a/''

o %ea%e 25(H=)D 'no a ae #o%3/!15 Co-G 'ne% R an% IN= ea-en -a e%3/e e3-

/on/ena'on o. 3e.3l 'a-'n D -eaol'e

2–4!15 So-e ART %37 3/" a e. a' en?

(EP,)7 "ae alo een ao/'ae% '" 'a-'n D%e.'/'en/!1K I ' "ee.oe #o'le "a lo ael'ne

'a-'n D leel ae .3"e /o-#o-'e% %3

"ea# 'n =I,TB /o'n.e/e% #o#3la'on!

T"e #een 3% a'-e% o %e/'e '6 .a/o .o

ael'ne 'a-'n D %e.'/'en/ 'n a /o"o o. alaG

'an a%3l '" #3l-ona TB7 ae "e ela'onG

"'# eeen 25(H=)D /on/ena'on an% ea-en

e#one7 an% eal3ae "e"e "e a%-'n'a'on o.

R7 IN= an% ART ' %elee'o3 o 'a-'n D a3

%3'n ea-en!

ET=HDSa'en e/3'-en an% .ollo3#

T"' o6 a nee% '"'n a lon'3%'nal /o"o

3% o. e#one o an'3e/3lo' ea-en

a-on ala'an a%3l a Q3een El'?ae" Cenal

=o#'al 'n Blane7 ala'7 .o- 2010 o 2012!

Conen'n a%3l '" #33- -ea#o''e #3l

-ona TB a%e% RRU o RRRU .o a/'%.a

a/'ll' (APB) on V'e"lNeelen (VN) a'ne% l'%e

ee el''le!1+ E&/l3'on /'e'a 'n/l3%e%

"ae-olo'n

7K $%l7 /ea'n'ne !1++ l-ol$l7 oal 'l'3'n !51

l-ol$l7 alan'ne ana-'nae

!

200 'nena'onal3n'4 (IU)$l7 /l'n'/al a3 3e'e o. '--'nen

-oal' (=H #e.o-an/e /oe 418)7 #enan/7

an'G 3e/3lo' ea-en 'n "e la 5 ea7/o '/oe o'% "ea# o ael'ne e'an/e o

R an% IN=! All #a'en 3n%een /"e

a%'oa#" (CWR) an% #o'no./ae =I, eolo!

ART a aa'la le a//o%'n o na'onal

#oo/ol!19720 An'3e /3lo ' ea-en a

#e/'e% a//o%'n o NT 3'%el'ne:21 R7IN=7 #a?'na-'%e an% e"a-3 ol ee

a%-'n'ee% .o 8 ee67 .olloe% R an% IN=

.o 1K ee6! Pollo3# /on'n3e% .o 1 ea a.e

en% o. ea-en o 'n/o#oae ela#e ae4 'no .'nalo3/o-e!

a'en '" nea'e TB #33- /3l3e .o- "e

en% o. ea-en ona% o "o o##e% /o3"'n

an% e-a'ne% ell 3n'l 3% %'/"ae ee %e.'ne%

a ale /3e! T"oe "o ee /3l3e#o''e a

"e en% o. ea-en ee .a'l3e! T"oe "o ee

/3l3enea'e a "e en% o. ea-en7 3 "o

3e3enl e%eelo#e% #o''e /3l3e e e

ela#e! P'nal ea-en o3/o-e a %e.'ne% a

"e /o-#o'e 3n.ao3ale /l'n'/al en%#o'n o.

.a'l3e o ela#e!

,'a-'n D -ea3e-en

Se3- a-#le ee /olle/e% .o- ea/" #a'en a

ael'ne7 ee6 8 an% "e en% o. ea-en7 an% oe%

a +08C 3n'l anal' 'n a 'nle a/"! B'e.l7

25(H=)D2 an% D ee e&a/e% 3'n ?'n/ 3l#"ae

an% a/eon''le a #e/'#'an! Sa-#le ee /en'

.3e% o oa'n a 3#enaan! B'oanal' a4 #e.o-e% 3'n eee #"ae l'3'% /"o-aoaG #" /o3#le% o a an%e- -a #e/o-ee 'n ele/o

#a 'on'a'on #o''e -o%e! Q3an'.'/a'on o. 25(H=)D2 an% 25(H=)D -eaol'e a ae% on

-3l'#le ea/'on -on'o'n o. "e #e/'.'/ -a

an''on .o ea/" ae anale! Toal 25(H=)D

a "e 3- o. (H=)D2 an% (H=)D a ea/"

'-e#o'n! =ol'/6 %e.'n''on o. 'a-'n D a3

ee 3e%:22 "#o'a-'no' D '. 25(H=)D K+5

n-ol$l7 'a-'n D %e.'/'en/ '. K50 n-ol$l7 an%

eee 'a-'n D %e.'/'en/ '. K25 n-ol$l!

S#33- a/e'olo0

Bael'ne #33- a-#le ee aee% 3'n VN an%

a3a-'ne #"enol -ea -'/o/o#1+

o /on.'--ea #o'''7 an% ee e 3# .o /3l3e 3'n

ol'% -e%'a an% l'3'% o"! Po ol'% -e%'a7 1 -l o.

3n%e/ona-'nae% #33- a "o-oen'e% '" an

e3al ol3-e o. %'"'o"e'ol (H&o'%7 Ba'no6e7

U>)7 an% .'e e'al en.ol% %'l3'on ee #e#ae%

'n #"o#"ae 3..ee% al'ne 50 ll o. nea #33-

an% ea/" %'l3'on ee #lae% ono %3#l'/ae #lae o.

'%%leoo6 +=11 (BD7 S#a67 D7 USA) ole'/

a/'% al3-'n aa -e%'a -a%e ele/'e "e

a%%''on o. #ol-&'n B (200 U$-l)7 '/a/'ll'n (100

-$l)7 '-e"o#'- (10 -$l) an% a-#"oe'/'n B

(10–0 -$l)! A.e ee6 o. 'n/3a'on7 ''le

/oa/e'3- 3e/3lo' /olon'e %enoe% #o''e /3l3e an% %'l3'on 'el%'n 10–100 /olon'e

ee ele/e% .o /o3n'n! T"e ael'ne a/'lla

loa% a "e aeae lo10 /olon .o-'n 3n'$-l o.

#33- .o- %3#l'/ae #lae o. ea/" a-#le!

Hne -l o. ea/" #33- a-#le a %e/ona-'naGe% 3'n Na/elL/e'ne$o%'3- "%o&'%e

an% 'no/3lae% 'no GITe (/oa/e'al Go"

In%'/ao T3e7 BD7 S#a67 D7 USA)! T"ee ee

#la/e% 'n an 'n/3ao a +8C 3n'l "e 'nalle%

#o''e! T"e GenoT#e TBDR#l3 2!0 l'ne# oe

aa (=a'n L'.e S/'en/e7 Ne"en7 Ge-an) /onG.'-e% "a all ! 3e/3lo' 'olae ee R

an% IN=3/e#'le! Sa-#le "a %'% no 'nal

#o''e a + ee6 ee ea%e% a nea'e!

S#33- a-#le /olle/e% a 8 ee67 a en% o.

ea-en an% %3'n #oea-en .ollo3# ee

3e% o ae 2-on" -ea$/3l3e /one'on an%

allo/ae .'nal o3/o-e! All #e/'-en ee 'no/3la

e% ono ol'% -e%'a an% 'no o"7 an% ee e#oe%

a /3l3e#o''e '. ! 3e/3lo' e e'"e

-e"o%! T"oe '" no o" 'n an -e%'a ee

e#oe% a nea'e!

Daa anal' an% a''/al -e"o%

Daa ee %e/'e% 3'n non#aa-e'/ 3--aa''/! 3l'a'ae l'nea ee'on a 3e% o

ae .a/o /on'3'n o a'a'l' 'n ael'ne


3/10

e3- 25(H=)D! A l'nea a#e?o'% 3le a 3e% o

/al/3lae an aea 3n%e "e /on/ena'on '-e /3e

(AUC0–K -on") .o ea/" #a'en7 e#een'n oal

25(H=)D eo3e %3'n an'3e/3lo' ea

-en! Lo''/ ee'on a 3e% o 3% ela'onG

"'# eeen ael'ne 25(H=)D an% ea-ene#one (2-on" -ea o /3l3e a3 an% .'nal

o3/o-e)! Rela'on"'# eeen /"ane .o- ae

l'ne /on/ena'on %3'n ea-en o AUC0–K -on"an% .'nal o3/o-e ee alo eal3ae%! Re3l o.

l'nea an% lo''/ ee'on anale ee eee%

a ee'on /oe..'/'en o o%% a'o (HR) '"

95 /on.'%en/e 'neal (CI)! T"e >36alall'

e a 3e% o ae a'a'l' 'n a4el'ne25(H=)D a %'..een e/3'-en -on"7 an%

AUC0–K -on" a'a'l' a-on #a'en "o 'n''a

e% ART a %'..een ae o. an'3e /3lo4'4

ea-en! C"ane 'n 25(H=)D a %'..een '-e #o'n ee anale% 3'n #a'e% 'l/o&on e!

S'n'.'/an/e a e#oe% a 7 0!05!

E"'/

E"'/ a##oal .o "' 3% a ane% "e

L'e#ool S/"ool o. To#'/al e%'/'ne7 L'e #ool7U>7 an% "e Collee o. e%'/'ne Reea/" E"'/4Co--'ee7 Un'e' o. ala'7 Blane7 alaG'! 'en 'n.o-e% /onen a #o'%e% all

#a '/'#an4!

RESULTS

a'en an% o3/o-e4

Bael'ne /"aa/e''/ o. "e 1K9 #a'en e/ 3'e%

ae o3l'ne% 'n "e Tale! T"e -e%'an ae a 1

ea 11K (K9) ee -ale! T"e -e%'an o% -a

'n%e& (BI) a 18!4 6$-27 an% (20) #a'en

e#oe% .oo% 'ne/3' (%e.'ne% a e3lal -''n

-oe "an one -eal #e %a 'n "e la -on")! H. "e

1K9 #a'en7 52 (K) "a% /a''e on CWR 98

(58) ee =I,'n.e/e%7 '" a -e%'an CD4 /o3n

o. 1K /ell$ll!

P'3e 1 "o #a'en een'on an% # oe

"o3" ea-en o. "e 3% #a'/'#an! A 8

ee67 14+ 'n%''%3al e-a'ne% 'n "e 3%! Po

"oe '" #33- -ea an% /3l3e e3l a "'

'-e7 22$141 (1K) #a'en e-a'ne% -ea #o''e

an% 9$11 (0) e-a'ne% /3l3e#o''e! He G

all7 1 #a'en e-a'ne% 'n "e 3% 3n'l allo/a'on

o. a .'nal o3/o-e: 118 (89) a/"'ee% ale /3e7

"'le 15 (11) "a% 3n.ao3ale o3/o-e!

A ael'ne7 2+$98 () =I,'n.e/e% #a'en

ee 3n%eo'n ART! B 3% %'/"ae7 K4$+K

(84) =I,'n.e/e% #a'en ee 3n%eo'n ART!

T"e ART e'-en a-on 3% /o-#lee a a.ollo: 5+ (89) e/e'e% a3%'ne (%4T)7

la-'3%'ne (TC) an% ne'a#'ne (N,)7 1 (2)e/e'e% ?'%o3%'ne7 la-'3%'ne an% ne'a#'ne7 (5) e/e'e% eno. o' (TDP)7 TC an% EP, an% (5) ee ae% on %4T7

TC an% N, 3 '/"e% o TDP7 TC an% EP,

%3'n an'3e/3lo' ea-en!

,'a-'n D a3 a ael'ne

Bael'ne e3- 25(H=)D /on/ena'on ee aa'lGale .o 1KK #a'en7 '" a -e%'an al3e o. 5+

n-ol$l: 29 (18) #a'en "a% 25(H=)D '"'n "e

no-al ane an% +2 (4) "a% "#o'a-'no' DE

K5 (9) "a% 'a-'n D %e.'/'en/7 18 (11) o.

"o- "a% eee %e.'/'en/! T"e %''3'on o.

25(H=)D -ea3e-en "o3"o3 "e 3% #o#

3la'on ' "on 'n P'3e 2!

T"e Tale an% P'3e "o "a7 on -3l'a'ae

anal'7 "e one .a/o ao/'ae% '" ael'ne

'a-'n D a3 a "e -on" o. e/ 3'-enE

#a'/'#an e/3'e% 'n J3l$A33 o Se#e-e $

H/oe "a% loe e3- 25(H=)D "an "o4e

e/3'e% 'n Jan3a$Pe3a ( M 0!001 an% M0!0047 e#e/'el)! Loe 25(HD) alo o//3e% 'n

#a'en '" .oo% 'ne/3' ( M 0!04) an% "oe

"o e3lal /on3-e% al/o"ol ( M 0!019)! T"ee

ee en% oa% loe /on/ena'on 'n #a'en

'" loe BI ( M 0!055) o "o /oo6e% 'n%oo

'" 'o-a .3el ( M 0!0KK)7 3 no ela'on"'#

eeen 'a-'n D a3 an% =I, 'n.e/'on #aa-Gee7 CWR /a'a'on o ael'ne a/'lla loa%!

P'3e 4 'll3ae "a7 on 3n'a'ae anal'7

"ee a no 'n'.'/an ela'on"'# eeen ael'ne

25(H=)D an% "e l'6el'"oo% o. a #o''e 2-on"

#33- -ea (HR 0!987 95CI 0!9K–1!007 M

0!129) o a #o''e 2-on" #33- /3l3e (HR 0!997 95CI 0!9+–1!017 M 0!21)! S3#''nl7

"ee a a l'" en% oa% 3n.ao3ale .'nal

o3/o-e a "'"e ael'ne 25(H=)D (HR 1!027

95CI 1!00–1!057 M 0!09+)! A "e e..e/ '?e a

e -all an% a''/al 'n'.'/an/e a no

ea/"e%7 ' ' 3nl'6el "a "' a /l'n'/all elean!

"en 'a-'n D a3 a anale% a a /aeo'/al

a'ale '" /3o.. a 257 50 o +5 n-ol$l7 "ee

ee no ao/'a'on '" an -a6e o. ea-en

e#one (%aa no "on)! 3l'a'ae -o%el ee

alo /on3/e% o eal'" "e"e 'n/o#oa'on

o. o"e a'ale .o- "e Tale 'n.l3en/e% e#on4e

o ea-en! Al"o3" a%an/'n ae (HR 1!127

95CI 1!0–1!227 M 0!008) a 'n%e#en%enl

ao/'ae% '" #o''e 2-on" #33- -ea7 all

-3l'a'ae -o%el ee /on'en '" "e /on/l3G'on .o- P'3e 4 "a "ee ee no 'n'.'/an

ela'on"'# eeen 25(H=)D /on/ena'on an%

ea-en e#one!

,'a-'n D a3 %3'n an'3e/3lo' ea-en

Ten% 'n e3- 25(H=)D /on/ena'on oe '-e

ee aee% .o "e 1 #a'en "o ea/"e% a .'nal

o3/o-e! e%'an e3- 25(H=)D oe o K2 n-ol$l

ee6 8 o. ea-en an% K4 n-ol$l en% o. ea-en (P'3e 5)! T"' o//3e% %e#'e %a'l

a%-'n'a'on o. R an% IN= o all #a'en an%


4/10

,'a-'nD

'n

TB:

('46

.a/o(4an%o3/o-e4

90+

Tale ,a'ale ao/'ae% '" ael'ne e3- 'a-'n D /on/ena'on 'n a%3l ala'an #a'en '" #3l-ona 3e /3lo4'4

,a'ale

De-oa#"'/ an% n3''onal

Co"o 3--a0(n M 1K9)

n ()

Un'a'ae anal' 3l'a'ae anal04'4

Ree'on /oe..'/'en 95CI al3e Ree'on /oe..'/'en 95CI al3e

Ae7 ea7 -e%'an IQR 1 2K–+ 0!25 0!K4 o 0!1 0!198 X X X

ale e& 11K (K9)

+!01 14!4 o 0!42 0!0K4 !80 11!42 o !8 0!2+B1I7 6$-27 -e%'an IQR 18!4 1+!1–20!0 1!2 0!12 o 2!+K 0!0+2 1!4 0!0 o 2!+1 0!055Poo% 'ne/3' (20) 8!22 1K!95 o 0!51 0!0K5 8!K+ 1K!K8 o 0!KK 0!04

9

Coo6 '" 'o-a .3el:

In'%e "e "o3e 19 (11) 1!1+ 25!05 o 1!29 0!00 10!K1 21!95 o 0!+ 0!0KKH3%oo 98 (58) 0!11 +!++ o +!55 0!9++ 0!51 +!92 o K!91 0!89

Re3lal %'n6 al/o"ol 52 (1) 9!84 1+!2+ o 2!41 0!010 9!2K 1K!9+ o 1!55 0!0199

on" o. e/3'-en;

Jan3a–Pe3a 1+ (10) X X X X X X a/"–A#'l 25 (15) 5!8 19!K0 o +!94 0!404 K!15 19!18 o K!89 0!5a–J3ne 29 (1+) 12!28 25!5+ o 1!01 0!0+0 11!44 2!95 o 1!0K 0!0+J3l–A33 2 (14) 25!00 8!89 o 11!11 70!001 21!84 4!99 o 8!K8 0!001

9

Se#e-e–H/oe 2 (19) 19!K8 2!+4 o K!K1 0!00 18!82 1!54 o K!10 0!0049

Noe-e–De/e-e 4 (25) +!4 19!9K o 5!11 0!244 4!4 1K!52 o +!K5 0!4+0

=I, #aa-ee 4=I,G'n.e/e% 98 (58) 4!0 2!+ o 11! 0!229 X X X CD4 /o3n7 /ell4$ll7 -e%'an IQR 1K8 95–19 0!0 0!00 o 0!0K 0!095 X X X Hn ART a ael'ne < 2+ (28) 5!0K 0!K+ o 1K!8 0!94 X X X

Ra%'olo'/al an% -'/o'olo'/al e&en o. %'eaeCa''e!4 /- on CWR 52 (K) 1!50 9!8 o K!9 0!+08 X X X Bael'ne a/'lla loa%7 lo10/.3$-l7 -e%'an IQR K! 5!1–+!8 0!+2 1!K0 o !05 0!540 X X X

De.'ne% a -''n -eal %3e o la/6 o. .oo% 'n "e la -on"!Sa''/all'n'.'/an!

a'en "o %'% no /oo6 '" 'o-a .3el 3e% a e.een/e .o l'nea ee'on!

;Jan3a–Pe3a 3e% a "e e.een/e -on" .o l'nea ee'on!

<e/enae eee% a #o#o'on o. =I,G'n.e/e% #a'en!

CI M /on.'%en/e 'neal IQR M 'ne3a'le ane B1I M o% -a 'n%e& =I, M "3-an '--3no%e.'/'en/ '3 ART M an'eo'al "ea# CWR M /"e Wa /.3 M /olon.o-'n 3n'!


5/10

140 T"e Inena'onal Jo3nal o. T3e/3lo' an% L3n D'eae

P'3e 1 a'en een'on7 #oe an% o3/o-e! 8ee6

#33- -ea e3l aa'la le .o 141 #a'en4! 8ee6

#33- /3l3e e3l aa'lale .o 11 #a'en! Un.ao3aleo3/o-e M .a'l3e a en% o. ea-en (n M 10) R #oea-en ela#e (n M 5)! =I, M "3-an '--3no%e.'/'en/'3 ART M an'eo'al "ea# TB M 3e /3lo'!

'n/eae% 3e o. ART =I,'n.e/e% #a'/'#an!

P'3e K "o "a 25(H=)D AUC0–K -on" a no

'n.l3en/e% =I, a3 o '-e o. ART 'n''a'on!

T"ee a 'n3..'/'en 3e o. ART e'-en o"e

"an %4T7 TC an% N, o eal'" "e"e

%'..een %3 /o-'na'on 'n.l3en/e% 25(H=)D

eo3e %3'n ea-en!

P'3e 2 ='oa- o. ael'ne e3- 25(H=)D /on/ena

'on! H. 1KK #a'en '" e3- 25(H=)D /on/ena'on

-ea3e% a ael'ne7 29 (18) "a% e3l '"'n "e no-al

ane an% +2 (4) "a% "#o'a-'no' D K5 (9) "a%

'a-'n D %e.'/'en/7 18 (11) o. "o- "a% eee %e.'/'en/ !

P'3e E..e/ o. eaonal' on ael'ne e3- 25(H=)D

/on/ena'on! Se3- 25(H=)D /on/ena'on .o- "e 1KK

#a'en '" ael'ne %aa ee loe 'n 3% #a'/'#an

e/3'e% %3'n o *3 a.e "e /ol% eaon! T"e al3e

"o'n eaonal %'..een/e 'n e3- 25(H=)D /on/ena'ona %e'e% .o- "e >346alGall'4 e!

P'3e 4 %e-onae "a /"ane .o- a4el'ne25(H=)D /on/ena'on a 8 ee6 (HR 1!007 95CI

0!9+–1!047 M 0!809) o en% o. ea-en (HR 0!9917

95CI 0!9+–1!027 M 0!490) a no ao/'ae%

'" .'nal o3/o-e7 no a 25(H=)D AUC0–K -on"(HR 1!007 95CI 0!99–1!007 M 0!21)!

DISCUSSIHN

T"e ole o. 'a-'n D 'n an'3e/3lo' ea-en

"a een 3*e/ o #olone% %eae! H3 %aa

"o "a 'n a eo3/e#oo #o#3la'on '" "'"ae o. ael'ne 'a-'n D %e.'/'en/7 a'a'l' 'n

e3- 25(H=)D /on/ena'on %'% no 'n. l3en/eea-en e4 #one!

T"e ae o. 'a-'n D %e.'/'en/ (9) a-on TB

#a'en 'n o3 3% a l'"l loe "an "a

%e/'e% #e'o3l a "e a-e /ene 'n ala'

(42)!2 =oee7 "e #e'o3 3% onl e/ 3'e%

#a'en 'n J3l7 "'le e e/3'e% all ea o3n%7 an%

o3 'a-'n D %e.'/'en/ ae .o J3l$A33 a-3/" "'"e7 a +0! Al"o3" "e n3-e o.

%al'" "o3 'n ala' %oe no /"ane eeen

eaon7 a e-#ea3e %o# .o- a o A33

e%3/e 3nl'" eo3e7 a #eo#le e-a'n 'n%oo


6/10

P'3e 4 ,a'a'l'0 'n e3- 25(H=)D /on/ena'on e#one o an'3e/3lo' ea-en: A–C) %'..een/e 'n ael'ne e3-

25(H=)D /on/ena'on 2-on" #33- -ea a3 (n M 141)7 2-on" #33- /3l3e a3 (n M 11) an% .'nal /l'n'/alo3/o-e (n M 1)7 e#e/'el D) /"ane 'n 25(H=)D /on/ena'on .o- ael'ne o 8 ee6 E) /"ane 'n 25(H=)D

/on/ena'on .o- ael'ne o en% o. ea-en /l'n'/al o3/o-e (n M 1) P) 25(H=)D eo3e a/o "e %3a'on o. ea-en7 e#eene% "e aea 3n%e "e /on/ena'on '-e /3e /l'n'/al o3/o-e (n M 1)! All al3e ae %e'e%

.o- lo''/ ee'on anal'!

an% ea a%%''onal lae o. /lo"'n! Daa .o-

o"e e'n 'n%'/ae "a 'a-'n D leel %o# 1

-on" a.e a /"ane 'n eo3e o 3la'ole

a72–25 an% o3 e3l ae /on'en '" "'!

P33e 3%'e 'n ala' "o3l% a6e a//o3n o.

eaonal #e'o%'/'!

H"e "an -on" o. e/3'-en7 -o .a/o

l'n6e% o ael'ne 25(H=)D a'a'l' ee elae%o %'ea o o/'al /'/3-an/e (.oo% 'ne/3'7

al/o"ol /on3-#'on7 lo BI an% /oo6'n 'n%oo

'" 'o-a .3el)! Cl'n'/al .a/o7 'n/l3%'n =I,

a37 ael'ne a/'lla loa% o a%'olo'/al e&en

o. %'eae7 ee no '-#l'/ae%! T"' oa%l /ooG

oae o"e e#o772472K72+ an% 3e "a

en'on-enal /on%''on ae "e 6e %'e o.

'a-'n D %e.'/'en/!

Heall7 'a-'n D %e.'/'en/ ae e#oe% 'n

ala' ae "'"e "an "oe %e/'e% 'n TB #a'en

/o"o 'n G3'neaB'a3 (8!5)728 3 loe "an

"oe e#oe% 'n So3" A.'/a (80)!24 T"' %eee

o. e'onal a'a'on 3n%el'ne "e nee% .o /a3'on"en e&a#ola'n e3l o. 'a-'n D 43%'e4

eeen A.'/an e'n!

No anal' o. e3- 25(H=)D /on/ena'on

%e/'e% a 'n'.'/an ela'on"'# eeen 'a-'n

D a3 an% #33- -ea o /3l3e #o''' a 2

-on" o .'nal o3/o-e! T"' /ona '"

#e'o3 %aa .o- Tan?an'a7 "'/" e#oe% "a

loe ael'ne 25(H=)D /on/ena'on ee ao/'G

ae% '" #oea-en ela#e!1 T"e eaon .o

"' ae 3n/lea7 3 "e oeall 3n.ao3ale o3G/o-e ae a "'"e 'n Tan?an'a (19 ! 11 'n

o3 3%)7 3e'n "a "ee ee 3n%el'n

%'..een/e eeen "e /o"o! P3"e-oe7 "e

Tan?an'an /o"o "a% "'"e ael'ne 25(H=)D

/on/ena'on (-e%'an +0 ! 5+ n-ol$l)7 an% "e

-a'n o3/o-e %'..een/e a eeen #a'en '"

leel !+5 ! K+5 n-ol! I ' #o'le "a e

e/3'e% an 'n3..'/'en n3-e o. #a'en '"

25(H=)D /on/ena'on !+5 n-ol$l "e"ol% o

%ee/ "e a%anae ee'en/e% "' o3#!

=oee7 "e e3l o. o3 3% 3##o "ee

/l'n'/al 'al "a "oe% no ene.' o. 'a-'n D

3##le-ena'on %3'n an'3e/3lo' ea-en7%e#'e 'n'.'/an elea'on 'n 25(H=)D /on/ena

'on a-on #a'en "o e/e'e% 3##le-en!10–12


7/10

P'3e 5 Se3- 25(H=)D /on/ena'on %3'n an'3e/3lo' ea-en! Daa onl "on .o "e 1 #a'en "o /o-#lee%"e 3%! Se3- 25(H=)D /on/ena'on a%3all 'n/eae% oe '-e on an'3e/3lo' ea-en! D'..een/e eeen-ea3e-en a %'..een '-e ee anale% 3'n #a'e% 'l/o&on e! R M '.a-#'/'n = M 'on'a?'% V M #a?'na-'%e E M

e"a-3olE =I, M "3-an '--3no%e.'/'en/ '3 ART M an'eo'al "ea#!

I ' ea3'n o noe "a 25(H=)D /on/ena

'on 'n/eae% oe '-e7 %e#'e #e'o3 e#o

"a R7 IN= an% o-e ART %3 -a e%3/e "e

'oaa'la'l' o. a/'e 'a-'n D -ea ol'e4!

I-#oe% 25(H=)D /on/ena'on %3'n "e /o3e

o. an'3e/3lo' ea-en ee alo oee% 'n a

3% 'n Tan?an'a!29 e #o#oe "a 'n/ ea4e%

%'ea 'na6e an% o3%oo a/'' %3'n e/oe

.o- TB /on'3e o '-#oe% 'a-'n D leel7

an% a%e3ael /o-#enae an %elee'o3 %3

e..e/ on -eaol'-! I ' no #o'le o %e.'n''el/on.'- "' "#o"e' '" o3 %aa7 3 ' %oe

a##ea "a o3'ne 25(H=)D 3##le-ena'on ' no

e3'e% o #een e&a/ea'on o. ael'ne %e.'/'en

/ 'n o3 e'n!

T"ee ee eeal l'-'a'on o "' o6! A

onl #a'en '" #33- /3l3e#o''e TB e e

'n/l3%e%7 no /o--en /an e -a%e ao3 'a-'n D

leel 'n e&a#3l-ona %'eae! T"e 'a-'n D

e/e#o eno#e o. o3 #a'en a 3n6non7 an%

one /l'n'/al 'al "a 3ee% "a 'n%''%3al '"

"e eno#e o. "e TaI e/e#o #ol0-o #"'4-

ae -oe l'6el o e#on% o 'a-'n D 43##le-enGa'on!0 Na'onal ART #oo/ol %3'n "e 43%

%'/ae% "a -o #a'en %'% no e/e'e EP,7 a

P'3e K C"ane 'n e3- 25(H=)D /on/ena'on .o-

ael'ne o en% o. ea-en 'n =I, #a'en '-'n o. ART

'n''a'on! Daa onl "on .o "e 1 #a'en "o /o-#lee%

"e 3%! T"ee a no %'..een/e 'n oal 25(H=)D eo3e7 a-ea3e% oal '-e 3n%e "e /on/ena'on'-e /3e

eeen non=I,'n.e/e% #a'en an% =I,G'n.e/e% #a'en7

' e#e/'e o. "e '-'n o. ART 'n''a'on %3 'n an'G3 e /3lo'4 ea-en! T"e al3e a %e'e% "e>346alGall'4 e! =I, M "3-an '--3no%e.'/'en/ '3 ARTM an'eo'al "ea# TB M 3e/3lo'!


8/10

%3 #e'o3l ao/'ae% '" 'a-'n D %e. '/'enG

/!1K P'l'ne ART e/o--en%a'on .o TB #aG'en "ae 'n/e /"ane%7 an% ' ' #o'le "a "e

e..e/ o. ART on 'a-'n D -eaol'- a'e 0ea-en e'-en!

CHNCLUSIHNS

,'a-'n D %e.'/'en/ e-a'n /o--on a-on ne

#3l-ona TB #a'en 'n ala'! So/'al an% en'Gon-enal .a/o7 #a'/3lal eaonal'7 ae

"e -a'n %'e o. a'a'l' 'n 'a-'n D a3 3

"'4 a'a'l' %oe no 'n.l3en/e ea-en e#one!An0 a%ee #"a-a/olo'/al e..e/ o. an'G3 e/3lo4'4 an% ART %3 on 'oaa'la'l' o. 25(H=)D a e /o-#enae% "e #o''e e..e/ o.

/l'n'/al e/oe 0!

A/6nole%e-en4

T"e 3% a 3##oe% a ell/o-e T3 (Lon%on7 U>)

Cl'n'/al "D Pello"'# aa%e% o DS (08K+5+$V$08$A) an% "e

ala' L'e#ool ell/o-e T3 (L) Coe an .o- "e

ell/o-e T3! T"e a3"o o3l% l'6e o "an6 A %olo a "e

Un'e' o. ala' Collee o. e%'/'ne TB Laoao7 Vo-a7

ala'7 an% G Ban%a an% C G3en%e a "e ala' L'e#ool

ell/o-e T3 Cl'n'/al Reea/" oa--e .o /on'3'n o

"' o6! P'nall7 e "an6 "e #a'en an% "e' .a-'l'e7 "oe

#a'/'#a'on an% /oo#ea'on -a%e "' 3% #o'le!

Con.l'/ o. 'nee: none %e/lae%!

T"' ' an o#en a//e a'/le %''3e% 3n%e "e e- o. "e

Cea'e Co--on A'3'on L'/ene7 "'/" #e-' 3ne'/e%

3e7 %''3'on7 an% e#o%3/'on 'n an -e%'3-7 #o'%e% "e

o''nal a3"o an% o3/e ae /e%'e%!

Re.een/e

1 ol% =eal" Han'?a'on! Gloal 3e/3lo' e#o! =H$=T$TB$2014!08! Genea7 S'?elan%: =H7 2014!

2 Ban%a R7 "e-e%' B7 Alla'n T J! ealen/e o. 'a-'n D%e.'/'en/ 'n a%3l 3e/3lo' #a'en a a /enal "o#'al 'nala'! In J T3e/ L3n D' 2011 15: 408–410!

aala F7 Nan3l3 7 Ban%a R ,7 "e-e%' B7 "'e S A7Alla'n T J! ,'a-'n D %e.'/'en/ 'n -e%'/al #a'en a a /enal"o#'al 'n ala': a /o-#a'on '" TB #a'en .o- a #e'o3 3%! LHS HNE 201 8: e5901+!

4 Roo6 G A7 Seele J7 Pa"e L7 e al! ,'a-'n D7 a--a'ne.e on7

an% /onol o. #ol'.ea'on o. /oa/e'3- 3e/3lo' "3-an -ono/e! I--3nolo 198K 5+: 159 – 1K!

5 Ro/6e > A7 Boo6e R7 U%aloa I7 ,'%al ,7 ='ll A ,7>'a6o6' D! 1725%'"%o&'a-'n D 'n%3/e n''/o&'%e n"ae an% 3##ee o" o. /oa/e'3-3e/3lo' 'n a "3-an -a/o#"ael'6e /ell l'ne! In.e/I--3n 1998 KK: 514–521!

K Sl L 7 Lo#e? 7 Na3ee. 7 Re'ne N E! 1 al#"a725%'"%o&'a-'n D'n%3/e% -ono/e an'-/oa/e'ala/'' ' e3lae% #"o#"a'%l'no'ol 6'nae an%-e%'ae% "e NAD=%e#en%en #"ao/e o&'%ae! J B'olC"e- 2001 2+K: 5482–549!

+ L'3 T7 Sene S7 L' =7 e al! Tolll'6e e/e#o 'e'n o. a'a-'n D-e%'ae% "3-an an'-'/o'al e#one! S/'en/e200K 11: 1++0–1++!

8 a'nea3 A R7 'l6'non > A7 Neon S 7 e al! IPNa--a an% TNP'n%e#en%en 'a-'n D'n%3/'le "3-an3##e'on o. -/oa/e'a: "e ole o. /a"el'/'%'n LL+! J

I--3nol 200+ 1+8: +190–+198!9 F36 J 7 S"'n D 7 Lee = 7 e al! ,'a-'n D 'n%3/e

a3o#"a 'n "3-an -ono/e$-a/o#"ae 'a /a"el'/'%'n!Cell =o '/oe 2009 K: 21–24!

10 a'nea3 A R7 T'-- 7 Bo"a-le G =7 e al! ='"%oe

'a-'n D %3'n 'nen'e#"ae an'-'/o'al ea-en o.

#3l-ona 3e/3lo': a %o3lel'n% an%o-'e% /onolle%

'al! Lan/e 2011 ++: 242–250!

11 Ral#" A 7 aa-o' G7 onoo'n G J7 e al! La'n'ne an%'a-'n D a%*3n/'e "ea#'e 'n #3l-ona 3e/3lo': a

an%o-'e%7 %o3lel'n%7 #la/eo/onolle% 'al! LHSHNE 201 8: e+002!

12 e*e C7 Go-e , P7 Rana 7 e al! ,'a-'n D a43##le-ena ea-en .o 3e/3lo': a %o3lel'n%7

an%o-'?e%7 #la/eo/onolle% 'al! A- J Re#' C' Cae

e% 2009 1+9: 84–850!

1 e"a S7 33' P 7 Bo/" R J7 e al! ,'a-'n D a3 an% TBea-en o3/o-e 'n a%3l #a'en 'n Tan?an'a: a /o"o3%! BJ H#en 201 : e00+0!

14 Bo%'e J7 Boo' A R7 ='lla% C J7 Aeae6ea G7

a/Ine I7 a6 B >! E..e/ o. 'on'a?'% on 'a-'n D

-eaol'- an% "e#a'/ -onoo&enae a/''! Cl'n

"a-a/ol T"e 1981 0: K–K+!

15 Bo%'e J7 Boo' A R7 ='lla% C J7 e al! E..e/ o. '.a-#'/'n

an% 'on'a?'% on 'a-'n D -eaol'-! Cl'n "a-a/ol T"e

1982 2: 525–50!

1K el? T7 C"'l% >7 Ia"'- P7 e al! E.a'en? ' ao/'ae% '"eee 'a-'n D %e.'/'en/ an% 'n/eae% al6al'ne #"o#"aae!

AIDS 2010 24: 192–1928!

1+ L3- R7 ,an De3n A7 Ba'an I7 P'?Geal% ! Laoao 0%'ano' o. 3e/3lo' #33- -'/o/o#! a'7 Pan/e:Inena'onal Un'on Aa'n T3e/3lo' an% L3n D'eae7201 " #:$$ ! "e3n'on!o $"aGeG%o$#3l '/a'on $e/"n'/al$la o ao 0%'ano4'4o.3 e /3lo4'40G4 #33-G-'/o/o#"e"an%oo6! A//ee% A#'l 2015!

18 H6en 7 Cee/" R =7 To-e D C7 e al! To&'/' an%

e#one /'e'a o. "e Eaen Coo#ea'e Hn/olo Go3#!

A- J Cl'n Hn/ol 1982 5: K49–K55!

19 'n' o. =eal" ala'! G3'%el'ne .o "e 3e o. an'eo'al "ea# 'n ala'! % e%! L'lon'7 ala':

o=7 2008!

20 'n' o. =eal" ala'! Cl'n'/al -anae-en o. =I, 'n

/"'l%en an% a%3l! 1 e%! L'lon'7 ala': o=7 2011!

21 'n' o. =eal" ala'! Na'onal TB Conol oa--ean3al! K" e%! L'lon'7 ala': o=7 200+!

22 =ol'/6 P! Re3e/'on o. 'a-'n D %e.'/'en/ an% '/6e! J

Cl'n Ine 200K 11K: 20K2–20+2!

2 a/o J A7 =en J7 >oo'/? A7 e al! Seaonal #e'o%'/'

o. e3- 'a-'n D an% #aa"o'% "o-one7 one eo#'on7

an% .a/3e: "e Geelon Heo#oo' S3%! J Bone 'ne

Re 2004 19: +52–+58!

24 a'nea3 A R7 N"a-oeon%e S7 Hn' T7 e al! Re/'#o/al

eaonal a'a'on 'n 'a-'n D a3 an% 3e/3lo'4no'.'/a'on 'n Ca#e Ton7 So3" A.'/a! o/ Nal A/a% S/'

USA 2011 108: 1901–1901+!

25 e'.o J 7 oo%le G 7 =o3" P S7 e al! T"e e..e/ o. eaon

an% la'3%e on 'n 'o 'a-'n D .o-a'on 3nl'" 'n

So3" A.'/a! S A. e% J 199K 8K: 12+0–12+2!

2K P'' =7 Rane N7 e%een L7 e al! =#o'a-'no' D '

/o--on a-on #3l-ona 3e/3lo' #a'en 'n Tan?an'a 3 ' no ela'ne% "e a/3e #"ae e#one! J N3 2008E

18: 24+4–2480!

2+ Nanea D7 Ga?'ano P 7 P'e%-an D J7 Bo >7 Jone A N7 =anen > E! ,'a-'n D an% /al/'3- leel 'n Uan%ana%3l '" "3-an '--3no%e.'/'en/ '3 an% 3e/3lo'!In J T3e/ L3n D' 2011 15: 1522–152+7 '!

28 e*e C7 Hleen R7 Rana 7 e al! Se3- 25"%o&'a-'n D

'n a e A.'/an #o#3la'on o. 3e/3lo' #a'en an%3n-a/"e% "eal" /onol! A- J Cl'n N3 200+ 8K: 1+K–

18!

29 To-ann A7 'el%e J 7 >''6' G S7 ,e"oe. =7 Boeee J7an %e ,en A J! Se3- 25"%o&'a-'n D /on/ena'on'n/eae %3'n 3e/3lo' ea-en 'n Tan?an'a! In J T3e/L3n D' 2010 14: 114+–1152!

0 Ele.ae' 7 /Elo D7 ea C 7 e al! Cenal -e-o

CD4 R T /ell e#one 'n /"on'/ =I, 'n.e/'on ae no eoe% an'eo'al "ea#! J I--3nol 2004 1+: 2184–2189!

http://creativecommons.org/licenses/by/4.0/http://creativecommons.org/licenses/by/4.0/http://creativecommons.org/licenses/by/4.0/http://creativecommons.org/licenses/by/4.0/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://www.theunion.org/what-we-do/publications/http://creativecommons.org/licenses/by/4.0/http://www.theunion.org/what-we-do/publications/


9/10

,'a-'n D 'n TB: '6 .a/o an% o3/o-e '

R E S U E

C H N TE W TE : Le %eY .'/' en 'a-'ne D e . eY 3en

/"e? le a%3le a.'/a'n ae'n %e 3e/3loe (TB)7e 'l

a eY eY %e 5+n-ol$l 4+ (28) #a'en on e3 3n eY

3la

7

50 n-ol$l7 /e4GaZ %'e7 3n %eY .'/' en 'a-'ne D!Le

#e3 e[ e

e&a/e eY

#a le e..e -eY aol'3e

%e4/on/ena'on 'n''ale %e 25(H=)D on eY eY #l3.a'le

-eY %'/a-en an'3e/3le3& e #a la "eY

a #'e an'eY o'ale (ART)! Hn ne a' #a

a'-en ' le %eY.'/' en 'a-'ne D 'n.l3en/e la eY

#one a3 a'e-en %e la TB!

HBJ E CT I P : DeY/'e le .a/e3 %e '3e %3 %eY .'/'

en 'a-'ne D 'n''al /"e? %e a%3le %3 ala' ae'n

%e

#en%an la a'on .o'%e ( 7 07001)7 ae/ l'n4eY

/3'eY al'-ena'e ( M 0704) o3 /"e? %e #a'en

3' /ono--a'en %e lal/ool ( M 07019)! Il n a #a

e3 %e ela'on ene le a3 en 'a-'ne D e la eY

#one a3 a'e-en %e la TB! Le /on/ena'on %e

25(H=)D e on a//3e %3an la "eY a#'e

an'3e/3le3e7 3el

TB #3l-ona' e7 eY al3e la ela'on ene

la

3e o' le a3 ,I= o3 le e/o3 aZ lAR T!

/on/ena'on 4eY '3e en 25 "%o&'a-'ne

D (25H=D) e la eY #one a3 a'e-en e eY

al3e ' la%-'n'a'on %e -eY %'/a-en

an'3e/3le3& e lART on 3n e..e neY a'. 3 le

a3 %e la 'a-'ne

C H N C L U S I H N S : Le %eY .'/' en 'a-'ne D

e4 . eY 3en /"e? le #a'en 3e/3le3& a3

ala'7 -a' 'l n'n.l3en/e #a la eY #one a3

a'e-en! Le e..e e/on%a'e -eY aol'3e

%e a'e-en4

D a3 /o3 %3 a'e-en! -eY %'/a-ene3&

#o3 a'en

e[ e /o-#eneY

#a

S C = EY A : E3%e %e /o"oe #o#e/'e

lon'3%'nale!l'-#a/ #o''. %e la 3eY 'on /l'n'3e 3' # eY 'en

R EY S U L T A T S :

HneY eY

e/3eY 1K9 #a'en

(583ne aaa'on %3 %eY .'/' en 'a-'ne D #en%an le

'n.e/eY #a le '3 %e l'--3no%eY .'/'en/e

"3-a'ne

,I=)! La /on/ena'on -eY %'ane 'n''ale %3

25(H=)D

a'e-en %e la TB!

R E S U 1 E N

A R C H D E R E PE R E N C I A: La %e.'/'en/'a %e 'a-'na D

e .e/3ene en lo a%3lo 3e #a%e/en 3e/3lo'

/on/ena/'oY n 4eY '/a %e 25(H=)D al /o-'en?o %el

e43%'o .3e 5+ n-ol$l! Se en/onoY %e.'/'en/'a %e

'a-'na D en

(TB) en AY .'/a 3 e&a/ea/'oY n #3e%e ela

4+ #a/'ene (28 750 n-ol$l)! La /on/en a/'one4

/one/3en/'a %e e.e/o -eaoY l'/o #oo/a%o #o

lo-e%'/a-eno an'3e/3loo

el aa-'eno

an'eoY\'/o (ART)! No e /lao ' ea

%e.'/'en/'a

eY'/a %e ae .3eon -aY a*a %3ane la

e- #oa%a .Y\a (

7

07001)7 /3an%o e&'\Ya'ne3'%a% al'-ena 'a ( M 0704) o en lo #a/'ene

3e /on3-\Yan al/o"ol ( M

'a-\Yn'/a 'n.l3e oe la e#3ea al aa-'eno %e la 07019)! No e o e oY

3na /oela/'oY n ene la

TB!

HBJ E T I , H S: De/'' lo .a/oe %e 'eo %e lo

#a/'ene a%3lo /on TB #3l-ona en ala' %e

3.' 3na %e.'/'en/'a %e 'a-'na D al /o-'en?o %el

e3%'o7 eal3a la /oela/'oY n ene la /on/ena/'oY

n 4eY '/a %e 25 "'%o&''a-'na D (25H=D)

la e#3ea al aa-'eno anal'?a ' la

a%-'n'a/'oY n %e -e%'/a-eno an'3e/3loo o

ART alea el ea%o %e la 'a-'na D %3ane elaa-'eno!

EY T H D H: P3e ee 3n e3%'o %e /o"oe

lon'3%'nal #o#e/'o!

R E S U L T A D H S: a'/'#aon en el e3%'o 1K9

#a/'ene (58 /on /o'n.e//'oY n #o el '3 %e

la 'n-3no%e.'/'en/'a "3-ana ,I=)! La -e%'ana %e

la


10/10

/on/ena/'oY n %e la 'a-'na D la e#3ea al

aa-'eno an'3e/3loo! La /on/ena/'one 4eY

'/a4 %e 25(H=)D a3-enaon %3ane el aa-'eno

an'3e/3loo7 'n%e#en%'ene-ene %e la '3a/'oY

n .ene al ,I= o la a%-'n'4 a/'oY n %el AR T!

C H N C L U S I HY N: La %e.'/'en/'a %e 'a-'na D

e.e/3ene en lo #a/'ene /on %'anoY '/o %e TB en

ala'7 #eo ea /aen/'a no a.e/a 3 e#3ea

al aa-'eno! Lo e.e/o -eaoY l'/o %e

lo4 -e%'/a-eno e /o-#enan /on el e.e/o #o''o

%e la e/3#ea/'oY n /l\Yn'/a7 lo /3al e'a 3na e&a/ea/'o

Y n %e la %e.'/'en/'a 'a-Y\n'/a %3ane el

aa-'eno %e la TB!

vit d deficiency in malawi

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