Low plasma zinc level and response to zinc supplement in HIV-infected patients who have immunological discordance after antiretroviral therapy

Purpose of the study: Immunological discordance in HIV‐infected patients is associated with the higher risk of mortality and disease progression. Zinc is an essential micronutrient for immune function. We aimed to determine plasma zinc level and immunological response after zinc supplementation in HIV‐infected patients with immunological discordance after antiretroviral therapy (ART). Methods: A pilot study of 2 phases including a cross‐sectional study to determine plasma zinc level in patients with immunological discordance and a prospective, randomized, open‐label, placebo‐controlled trial was conducted in HIV‐infected patients with immunological discordance in a medical‐school hospital. Immunological discordance was defined as patients who received ART, had complete virological response (HIV RNA Summary of results: Of 31 patients, median (IQR) plasma zinc level was 76 (66–88) µg/dL (IQR) and 12 (38.7%) patients had low plasma zinc level. Five of 12 patients with low plasma zinc level and 8 of 19 patients with normal plasma zinc level were randomized to receive zinc supplementation. Median (IQR) change of plasma zinc level after zinc supplementation in patients with low and normal plasma zinc level were 29 (−2–50) and−8 (−17–10) µg/dL, respectively. Significant increase of CD4 cell count after zinc supplementation was observed in patients with low plasma zinc level. Median (IQR) CD4 cell count at baseline and after zinc supplementation were 176 (161–200) and 250 (192–262) cells/mm[sup.3]. The effect of zinc supplementation compared to placebo on the rising of CD4 cell count was not significantly different in both patients with low and normal plasma zinc level. Conclusions: Low plasma zinc level is observed over one‐third of patients with immunological discordance. Zinc supplementation increases plasma zinc level and CD4 cell count in patients with low zinc level but the effect was not significant different from placebo. Further large‐scale study to determine long‐term benefit of zinc supplementation in patients with immunological discordance is needed.
References Martnelli L, Francisci D, Sgrelli A, Baldelli F. Epidemiological features, therapeutic strategies and long‐term immunological outcomes in virologically suppressed HIV+ very late presenters. J Int AIDS Soc. 2010;13(Suppl 4):P19. [...]