The effect of zinc supplementation on immune failure in HIV infected adults on stable antiretroviral therapy (ART)
A. Campa1, D. Jayaweera2, S. Lai3, Y. Li1, S. Sales1, J. Page2, M. Baum1
1Florida International University, R Stempel College of Public Health and Social Work, Miami, United States, 2University of Miami, Miller School of Medicine, Miami, United States, 3Johns Hopkins University, Bloomberg School of Public Health, Baltimore, United States
Background: Adequate zinc status is critical for immune function. The effects of zinc supplementation on the onset of immunologic failure defined as inadequate increase in CD4+ cell count, have not been adequately explored. Immunologic failure is associated with increased risk of clinical progression and mortality. Therefore, we investigated the benefits and safety of zinc supplementation in nutritional doses to prevent immunologic failure.
Methods: After informed consent, a cohort of 40 HIV+ participants on ART with suppressed HIV-viral load were randomly assigned into zinc supplementation (15 mg zinc for men and 12 mg for women), or placebo, and followed for 18 months. Blood was drawn for CD4 cell count, viral load and metabolic profiles. Questionnaires on treatment history and adherence were completed at baseline and every 6 months. Immunologic failure was defined as a drop of CD4+ cell count < 200 cells/mm3.
Results: Of the 40 participants, 27 (67.5%) were African-American, 36 (90%) were men, and mean age was 45.9±7.1 years. Viral load was continuously suppressed during the follow-up period for all participants. There was no significant difference between the two groups in the type and the duration of ART. In the Cox-Regression analysis, 7 participants were excluded at baseline due to immunologic failure (CD4 cell count < 200 cells/mm3). Four new events of immunologic failure were detected during the 18-month follow-up, all in the placebo group (21%) compared to none (0%) in the zinc group, Χ2=4.4, p=0.043.
Conclusions: Zinc supplementation at nutritional levels was safe and prevented immunologic failure in HIV infected patients on stable ART. Longitudinal studies with adequate sample size are needed to evaluate the benefits of zinc supplementation in HIV+ patients on ART. The evidence from this preliminary study indicates a potential benefit of zinc supplementation as an adjunct therapy in HIV+ adult cohorts on ART.
Funded by NIDA
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