Zinc-deficient children living in communities where
they do not receive adequate amounts of zinc from their
diet should be given supplements, even if they are
HIV-infected, according to researchers from the Johns
Hopkins Bloomberg School
of Public Health and other institutions.
Previously, it was not known if zinc would speed up
HIV disease progression in children by increasing their
viral load. Zinc supplementation is known to decrease the
frequency of diarrhea and pneumonia in uninfected children.
The study is published in the Nov. 26 issue of The
Lancet.
"We set out to look at the safety and impact of zinc
supplements in children with HIV. Not only did we learn
that zinc is safe for these children, but we also realized
that this may be a low-cost intervention to reduce
morbidity in HIV-infected children who don't have access to
antiretroviral therapy or are not eligible for treatment,"
said William J. Moss, senior author of the study and an
assistant professor in the Bloomberg School's
Department of Epidemiology.
The researchers completed a randomized, double-blind,
placebo-controlled trial of zinc supplementation at an
urban hospital in Pietermaritzburg, South Africa. The 96
children in the study were cared for on a monthly
outpatient basis by a team of medical doctors and nurses.
Parents were taught how and when to give the 10-mg zinc or
placebo tablets to their child every day for six months.
The children were seen at the hospital every two weeks for
the first month, monthly for five months and, as a final
visit, nine months after zinc or placebo supplementation
began. At each follow-up visit, parents were asked about
illnesses since the last visit. In addition, HIV-1 RNA in
plasma and CD4+ T lymphocyte cell counts were measured one
month before the study, at the first study visit and three,
six and nine months after the start of supplementation.
The study authors found no increase in plasma HIV-1
viral load measurements in the children receiving zinc,
meaning that zinc supplementation is safe for HIV-infected
children. The CD4+ T lymphocytes and hemoglobin
concentrations also were similar between the two study
groups. Importantly, HIV-infected children who received
zinc supplementation were less likely to get watery
diarrhea.
"Programs to increase zinc supplementation in
populations with a high prevalence of HIV infection can and
should be implemented, and can be done so now that we know
zinc does not have an adverse effect on HIV replication.
Also, in light of the fact that zinc is known to reduce
episodes of diarrhea and pneumonia, zinc supplementation
should be used as an adjunct therapy for children with HIV
infection," Moss said.
The study was funded by the Johns Hopkins Family
Health and Child Survival Cooperative Agreement with the
Office of Health, Infectious Diseases and Nutrition Global
Health Bureau at the U.S. Agency for International
Development.
Robert E. Black, chair of the Bloomberg School's
Department of International Health, co-authored the study.
Additional co-authors are Raziya Bobat, Hoosen Coovadia,
Cindy Stephen, Kimesh L. Naidoo and Neil McKerrow.
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