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Pyridoxal-5-phosphate plasma concentrations in children receiving tuberculosis chemotherapy including isoniazid

K Cilliers1, D Labadarios1, H S Schaaf1

  • 1Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa.

Acta Paediatrica (Oslo, Norway : 1992)
|February 12, 2010
PubMed

Insights

Pyridoxine (vitamin B6) levels were low in children with tuberculosis, especially those with HIV, during isoniazid treatment. Supplementation may be needed, particularly for HIV-infected children, to ensure adequate vitamin B6 nutriture.

Area of Science:

  • Pediatric Infectious Diseases
  • Nutritional Biochemistry
  • Public Health

Background:

  • Isoniazid (INH) treatment for tuberculosis (TB) can affect pyridoxine (vitamin B6) status.
  • Pyridoxine nutriture in children undergoing TB treatment, particularly those with HIV, is not well understood.

Purpose of the Study:

  • To document plasma pyridoxal 5'-phosphate (PLP) concentrations in HIV-infected and HIV-uninfected children receiving INH regimens.
  • To assess the impact of INH treatment on vitamin B6 status in pediatric TB patients.

Main Methods:

  • Plasma PLP concentrations were measured in hospitalized children with TB in South Africa at enrollment, 1 month, and 4 months after starting TB treatment.
  • Children received a supplement to meet pyridoxine requirements.

Main Results:

  • On enrollment, 50% of HIV-infected and 15% of HIV-uninfected children had suboptimal PLP levels (<6 ng/mL).
  • After 4 months of INH treatment, 42% of HIV-infected children still had suboptimal PLP levels, compared to 6% of HIV-uninfected children.
  • Mean PLP concentrations significantly differed between HIV-infected and HIV-uninfected children after 4 months of treatment (p < 0.001).

Conclusions:

  • Children treated for TB, both HIV-infected and HIV-uninfected, had low plasma PLP concentrations at the start of treatment.
  • Suboptimal pyridoxine status persisted in a significant proportion of HIV-infected children after 4 months of INH therapy.
  • Additional pyridoxine supplementation is recommended for malnourished children with TB, especially those who are HIV-infected.
Abstract

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