rifampin and Vitamin-D-Deficiency

Vitamin D deficiency is associated with susceptibility to active tuberculosis (TB) in many settings. In vitro studies and studies on human volunteers showed that two of the first-line anti-tuberculosis drugs, isoniazid and rifampicin, reduce 25-hydroxy vitamin D (25[OH]D) concentrations.. To study changes in vitamin D status during treatment of Tanzanian hospitalised patients with pulmonary TB (PTB).. We compared serum 25[OH]D concentrations in 81 Tanzanian PTB patients before and after 2 months of treatment.. Median serum 25[OH]D concentrations increased from 91 nmol/l at baseline to 101 nmol/l after 2 months of TB treatment (median increase 6.0 nmol/l, IQR -0.7-25.0, P = 0.001). Median serum parathyroid hormone concentrations increased from 1.6 to 2.0 pmol/l (median increase 0.46, IQR -0.2-1.1, P < 0.001).. 25[OH]D serum concentrations increased during the first 2 months of TB treatment in 81 PTB patients in northern Tanzania. Improved dietary intake and increased sunlight exposure may have contributed to the increased 25[OH]D concentrations.

Topics: Adult; Antitubercular Agents; Calcifediol; Female; Hospitalization; Humans; Isoniazid; Male; Parathyroid Hormone; Rifampin; Sunlight; Tanzania; Tuberculosis, Pulmonary; Vitamin D; Vitamin D Deficiency; Vitamins

Topics: Alkaline Phosphatase; Calcium; Child; Humans; Hypocalcemia; Male; Rifampin; Risk Factors; Vitamin D; Vitamin D Deficiency

Initiation of efavirenz-based combination antiretroviral therapy (cART) is associated with Vitamin D deficiency, but the risk factors including efavirenz pharmacokinetics for cART-induced severe vitamin D deficiency (SVDD) and the impact of anti-tuberculosis (TB) cotreatment are not explored. We investigated the prevalence of SVDD in HIV and TB-HIV coinfected patients and associated risk factors for treatment-induced SVDD.Treatment-naïve Ethiopian HIV patients with (n = 102) or without (n = 89) TB co-infection were enrolled prospectively and received efavirenz-based cART. In TB-HIV coinfected patients, rifampicin-based anti-TB treatment was initiated 4 or 8 weeks before starting cART. Plasma 25-hydroxyvitamin D (25 [OH]D), cholesterol and 4-beta hydroxycholesterol concentrations were measured at baseline, 4, 16, and 48 week of cART. Plasma efavirenz concentrations were determined at 4 and 16 weeks of cART.TB-HIV patients had significantly lower plasma 25 (OH)D3 levels than HIV-only patients at baseline. TB co-infection, low Karnofsky score, high viral load, and high CYP3A activity as measured by plasma 4β-hydroxycholesterol/cholesterol ratios were significant predictors of low 25 (OH)D3 levels at baseline. In HIV-only patients, initiation of efavirenz-based cART increased the prevalence of SVVD from 27% at baseline to 76%, 79%, and 43% at 4, 16, and 48 weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by -40%, -50%, and -14% at 4, 16, and 48 weeks of cART, respectively.In TB-HIV patients, previous anti-TB therapy had no influence on 25 (OH)D3 levels, but the initiation of efavirenz-based cART increased the prevalence of SVDD from 57% at baseline to 70% and 72% at the 4 and 16 weeks of cART, respectively. Median plasma 25 (OH)D3 declined from baseline by -17% and -21% at week 4 and 16 of cART, respectively.Our results indicate low plasma cholesterol, high CYP3A activity, and high plasma efavirenz concentrations as significant predictors of early efavirenz-based cART-induced vitamin D deficiency. Low plasma 25 (OH)D3 level at baseline is associated with TB co-infection and HIV diseases progression. Initiation of efavirenz-based cART is associated with high incidence of SVDD, whereas rifampicin based anti-TB therapy co-treatment has no significant effect. Supplementary vitamin D during cART initiation may be beneficial for HIV patients regardless of TB coinfection.

Topics: Adult; Alkynes; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Benzoxazines; Cholesterol; Cohort Studies; Cyclopropanes; Ethiopia; Female; HIV Infections; Humans; Male; Prevalence; Prospective Studies; Rifampin; Risk Factors; Treatment Outcome; Tuberculosis, Pulmonary; Vitamin D; Vitamin D Deficiency

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.

Topics: Adult; Antibiotics, Antitubercular; Brucellosis; Calcitriol; Calcium; Drug Therapy, Combination; Female; Humans; Hypocalcemia; Recurrence; Rifampin; Spasm; Spinal Diseases; Streptomycin; Vitamin D Deficiency

Topics: Humans; Hyperparathyroidism; Isoniazid; Rifampin; Vitamin D Deficiency

Topics: Adolescent; Adult; Anticonvulsants; Antipyrine; Barbiturates; Child; Dexamethasone; Drug Interactions; Drug Therapy; Enzyme Induction; Glucuronates; Glutethimide; Humans; Hydrocortisone; Hydroxycholecalciferols; Hypnotics and Sedatives; Male; Microsomes, Liver; Molecular Biology; Pharmaceutical Preparations; Rifampin; Vitamin D; Vitamin D Deficiency