Supplements Delay CD4 Cell Loss and Reduce Diarrhea in People with
HIV positive people who received zinc supplements in
a randomized clinical trial were about 75% less likely
to see their CD4 cell count drop below 200 cells/mm3
or fail to recover adequately after starting antiretroviral
therapy, according to a study published in the June
15, 2010 issue of Clinical Infectious Diseases.
Zinc recipients were also half as likely to have diarrhea.
These findings are important, as research indicates
that more than 50% of adults with HIV may have zinc
Marianna Baum from Florida International University in Miami and
colleagues examined the safety and efficacy of long-term zinc
supplementation and its relation to HIV disease progression. Adequate
zinc is critical for proper immune function, they noted as background,
but zinc deficiency occurs in more than half of HIV positive adults.
This prospective clinical trial included 231 HIV positive adult
participants with low plasma zinc levels (< 0.75 mg/L). They
were randomly assigned to receive zinc supplements (12 mg of elemental
zinc for women and 15 mg for men) or placebo for 18 months.
Most participants (73%) were men, 77% were black, and the average
age was 43 years. About two-thirds were on combination antiretroviral
therapy (ART), but 69% nevertheless had detectable viral load;
at study entry one-third had a CD4 cell count below 200 cells/mm3,
the danger zone for opportunistic infections.
HIV viral load and CD4 cell count were measured every 6 months.
Questionnaires, pill counts, and levels of plasma zinc and C-reactive
protein (a marker of inflammation) were used to monitor adherence
to supplements and ART. Immunological failure was defined as a
CD4 count < 200 cells/mm3.
supplementation for 18 months reduced the likelihood of immunological
failure by 4-fold versus placebo, after controlling for age,
sex, food insecurity, baseline CD4 count, viral load, and
ART (relative rate 0.24, or 76% reduction; P < 0.002).
a sub-analysis of participants who had undetectable viral
load on ART, the 4 patients who experienced immunological
failure were all in the placebo group.
participants achieved poor virological control despite ART,
but viral load was not affected by zinc supplementation.
supplementation reduced the frequency of diarrhea by 60% compared
with placebo (odds ratio 0.4; P = 0.019).
there was no significant difference in mortality between the
zinc and placebo groups.
"This study demonstrated that long-term (18-month) zinc supplementation
at nutritional levels delayed immunological failure and decreased
diarrhea over time," the investigators concluded. "This
evidence supports the use of zinc supplementation as an adjunct
therapy for HIV-infected adult cohorts with poor viral control."
In an accompanying editorial, Saurabh Mehta and Wafaie Fawzi from
Harvard School of Public Health described some of the biological
mechanisms by which zinc deficiency might be associated with disease
progression, including suppression of cell-mediated immunity,
decreased levels of a thymus hormone that stimulates T-cell differentiation,
impaired regeneration of CD4 cells, altered cytokine levels, and
increased inflammation in the gut.
Florida International University, R. Stempel College of Public
Health and Social Work, Miami, FL; University of Miami, Miller
School of Medicine, Miami, FL; Johns Hopkins University, Baltimore,
MK Baum, S Lai, S Sales, and others. Randomized, controlled clinical
trial of zinc supplementation to prevent immunological failure
in HIV-infected adults. Clinical Infectious Diseases 50(12):
June 15, 2010.
S Mehta and W Fawzi. Micronutrient supplementation as adjunct
treatment for HIV-infected patients (Editorial). Clinical Infectious
Diseases 50(12): 1661-1663. June 15, 2010.