Adjunctive micronutrient supplementation for pulmonary tuberculosis

Objective. To assess the effect of micronutrient supplementation on tuberculosis (TB) patient outcomes. Material and Methods. The randomized, double-blinded, placebo-controlled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/tratamiento acortado estrictamente supervisado (TAES/DOTS) at IMSS in Ciudad Juarez, Chihuahua, Mexico, who were recruited during August 2005-July 2006. Consecutive patients received zinc and vitamin A supplements or matched placebo for four months. Dietary intake, blood zinc and vitamin A, immune response (IFN-gamma,TNF-alpha, and IL-10 m RNA), and sputum smear conversion were measured. Results. The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased (p=0.03). This occurred subsequent to increased TNF-alpha and IFN-gamma and decreased IL-10 observed at month 2. Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy. Conclusions. The earlier elimination of bacilli from sputum was associated with improved zinc status and Th1 immune response. The therapeutic effect of vitamin A was less evident.