Comparison of Effectiveness of Anti-Tuberculous Therapy Alone and in Combination with Vitamin D Supplementation for Early Sputum Conversion in Smear-Positive Pulmonary Tuberculosis Patients with Optimal Vitamin D Levels

Abstract

Background: Tuberculosis (TB) continues to be a major global health concern, contributing significantly to morbidity and mortality despite standardized anti-tuberculous therapy (ATT). Vitamin D plays an immunomodulatory role by enhancing macrophage activity and stimulating the production of antimicrobial peptides. However, its additional therapeutic benefit in TB patients with optimal Vitamin D levels remains uncertain. Objective: To compare the effectiveness of anti-tuberculous therapy (ATT) alone versus ATT combined with Vitamin D supplementation in achieving early sputum conversion among smear-positive pulmonary tuberculosis patients with optimal Vitamin D levels. Methods: This randomized controlled trial was conducted at the Department of Medicine, Mayo Hospital, Lahore, over nine months from 10 August 2024 to 10 May 2025. A total of 112 newly diagnosed smear-positive pulmonary TB patients (aged 16–70 years) with optimal Vitamin D levels (30–50 ng/mL) were enrolled. Participants were randomly assigned to Group A (standard ATT) or Group B (ATT + Vitamin D 100,000 IU IM fortnightly during the intensive phase). Sputum conversion was assessed at 8 weeks. Data were analyzed using SPSS 26.0, with a chi-square test applied and significance set at p < 0.05. Results: The mean age of participants was 37.8±12.3 years, with 58 (51.8%) males. Early sputum conversion at 8 weeks occurred in 48 (85.7%) patients in Group A and 54 (96.4%) in Group B (p=0.041). No significant association was observed between sputum conversion and factors such as gender, BMI, or socioeconomic status. Conclusion: Adjunctive Vitamin D supplementation alongside standard ATT significantly improved early sputum conversion rates in smear-positive pulmonary TB patients, even among those with optimal baseline Vitamin D levels. These findings suggest a potential therapeutic benefit of Vitamin D in enhancing treatment efficacy. Further multicenter studies are recommended to confirm these outcomes and establish optimal dosing protocols.