Vitamin D Interventions in Tuberculosis Management

Vitamin D has emerged as a promising adjunct in the management of tuberculosis (TB) through its immunomodulatory and antimicrobial properties. The active metabolite, 1,25-dihydroxyvitamin D, binds to the vitamin D receptor in monocytes and macrophages, promoting expression of antimicrobial peptides such as cathelicidin and enhancing phagocytic killing of Mycobacterium tuberculosis. Epidemiological evidence links low serum 25-hydroxyvitamin D levels with increased susceptibility to TB infection and delayed sputum conversion during treatment. Genetic studies implicate polymorphisms in the vitamin D receptor and toll-like receptors as modifiers of individual response to both infection and supplementation. Randomised trials have tested a range of dosing regimens—from high-dose intramuscular boluses to daily oral supplementation—often alongside standard chemotherapy, with variable effects on clinical recovery, radiographic resolution and immunological markers. Meta-analyses suggest that vitamin D improves sputum smear and culture conversion rates, yet the impact on long-term outcomes and mortality remains uncertain. The global burden of both TB and vitamin D deficiency underscores the need for tailored interventions, especially in regions where sunlight exposure is limited or dietary intake is inadequate. Further research is focusing on optimal dosing strategies, host genetic factors and the integration of vitamin D therapy into host-directed treatment frameworks.

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Vitamin D Interventions in Tuberculosis Management publication trend

The graph below shows the total number of articles in vitamin d interventions in tuberculosis management across all publications each year (not limited to Nature Index journals).

Technical terms

25-hydroxyvitamin D (25(OH)D): The primary circulating form of vitamin D used to assess an individual’s vitamin D status.

Vitamin D receptor (VDR): A nuclear receptor that mediates the genomic effects of active vitamin D on immune and other cells.

Toll-like receptors (TLR): A family of pattern-recognition receptors that detect microbial components and activate innate immunity.

Odds ratio (OR): A statistical measure expressing the likelihood of an outcome in one group compared with another.

QuantiFERON-TB Gold Plus (QFT-Plus) assay: An interferon-γ release assay used to detect immune sensitisation to Mycobacterium tuberculosis antigens.

References

1. Vitamin D Status, VDR, and TLR Polymorphisms and Pulmonary Tuberculosis Epidemiology in Kazakhstan. Nutrients (2024).
2. Vitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicenter phase 3 double-blind randomized placebo-controlled trial (ViDiKids). International Journal of Infectious Diseases (2023).
3. Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis. PLOS Medicine (2019).
4. Effects of vitamin D supplementation on the outcomes of patients with pulmonary tuberculosis: a systematic review and meta-analysis. BMC Pulmonary Medicine (2018).
5. Vitamin D accelerates clinical recovery from tuberculosis: results of the SUCCINCT Study [Supplementary Cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin D supplementation in patients with pulmonary tuberculosis’. BMC Infectious Diseases (2013).
6. Oral intake of phenylbutyrate with or without vitamin D3upregulates the cathelicidin LL-37 in human macrophages: a dose finding study for treatment of tuberculosis. BMC Pulmonary Medicine (2013).
7. Vitamin D Deficiency and Tuberculosis Progression - Volume 16, Number 5—May 2010 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2010).
8. A Serum Vitamin D Level. PLOS ONE (2015).