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Chester Myers' Nutrition Series

Zinc Supplementation in HIV/AIDS

Zinc is an important micronutrient required for human health. About 100 enzymes are dependent on it, and both digestion and immunity critically depend on an adequate supply of it. Only about 1% of the body's supply exists in the blood. Even in healthy North Americans, deficiencies are fairly common. Logically, deficiencies are expected to be more common in males than in females since males lose zinc in their seminal fluid on ejaculation. Otherwise, both males and females lose zinc in sweat, urine and faeces.

There are conflicting opinions on zinc supplementation for those with HIV/AIDS. While almost all studies indicate positive effects from zinc supplementation, the conflict arises from one epidemiological study from Johns Hopkins University where an increase in risk of disease progression was associated with increasing levels of zinc intake. All other studies indicate not only that zinc deficiencies are associated with significant reduction in survival, but also that supplementation provides benefits including improvement in immune functions.

There are a number of arguments to be made for zinc supplementation.

  1. First of all, deficient serum levels of zinc are common in HIV/AIDS. While low serum levels that result from the acute phase response in a disease of a few days or weeks may be readily correctable by normal diet on resolving of the disease, in the case of a chronic disease such repletion is far less likely. Furthermore, in HIV/AIDS multiple micronutrient deficiencies are common and become increasingly more severe with disease progression in the absence of supplementation.
  2. Zinc absorption occurs in the small intestine and is not highly efficient even in healthy individuals. Malabsorption problems in the small intestine are common in HIV/AIDS. University of Miami researchers have recommended for those with HIV/AIDS an intake of 6X-10X the RDA levels in order to maintain normal serum levels (1992, 1994, 1995). It seems to be commonsense to maintain those levels considered important for human health.
  3. The data of the study showing an association between increasing zinc intake and increasing disease progression were very scattered. Another study (Berkeley campus, University of California) found that above a certain level of zinc intake there was a decrease in risk of disease progression with increasing zinc intake although their statistical analysis did not indicate significance. In addition to both studies having similar numbers of participants in each section of analysis, in the latter case, the 95% confidence levels were much narrower, i.e., the data were less scattered. This would seem to indicate that the statistical significances of the zinc data for each study were in fact rather similar. Furthermore, the Johns Hopkins study showed a similar association between increasing levels of B vitamin intake with increased risk of disease progression UP TO A CERTAIN LEVEL, BUT a dramatic decrease in risk of disease progression for the highest level of B vitamin intake, which was the only level that approached the levels recommended by the Miami group as being necessary to maintain serum adequacy. Almost all the participants of both epidemiological-type studies had zinc intake much lower than the levels recommended from Miami, so it seems possible a similar trend may be observed for both the B vitamins and zinc.
  4. A number of intervention studies have shown significant improvements in general health &/or immunity for people with HIV/AIDS on aggressive supplementation with zinc. In addition, it was noted by one research group in 1992 that AZT was observed to be most effective in those with the highest serum levels of zinc.
The intervention studies were short term studies, and it has not been apparent that there was a background multivitamin supplementation. While it seems to make sense that re-establishment of normal zinc levels should be attempted, nonetheless, data collected from people in a state of general micronutrient starvation would seem to be of dubious relevance. For now, we have information that results for people with HIV/AIDS from -carotene supplementation are quite different when a multivitamin is given, relative to no multivitamin being given. Of the above arguments, therefore, D. may be of limited support for aggressive supplementation.

Overall, the above arguments seem to me to argue for zinc supplementation in line with the Miami recommendations, i.e., 75 to 150 mg/day. If we get 15 mg/day from food, and another 15 mg/day from a multivitamin, then the common 50 mg zinc supplement puts us within the range recommended. For those who choose the 30 mg Jarrow Zinc Balance 30™ supplement, this may also be adequate since 15 mg is complexed with methionine, a thiol, which should make zinc absorption more efficient.

In HIV/AIDS, zinc is probably the micronutrient most in need of controlled study. It is important that such controlled study start from a baseline that approximates recognized serum adequacy, i.e., a multivitamin would be essential, preferably having been started several months prior to a controlled zinc study per se. In addition, it would seem to make sense for now that initial study start from the baseline of zinc intake provided by a normal diet AND the multivitamin. Simultaneous supplementation with NAC would seem advisable to maximize the likelihood that the level of the zinc/copper regulatory protein, metallothionein, is likely to be adequate [this protein should be monitored since it contains about 30% cysteine, another of the common deficiencies in HIV/AIDS].

In a general sense, interpretation of data for any single vitamin or mineral may be difficult unless the other vitamins and minerals are at least close to normal serum adequacy levels. Otherwise, those data for the single nutrient would be from people in a state of starvation.

Related monographs:
Information relating to HIV & Nutrition: HIV & Zinc and Copper revisited

Author, Chester Myers, holds both honours B.Sc. and M.Sc. (1969) degrees in physical chemistry from Dalhousie University, and a Ph.D. (1975) from the University of Toronto (biophysical chemistry) where he investigated the mechanism of action of one of the digestive enzymes. In addition to publishing in the scientific literature and having authored several patents, he has written extensively on topics regarding health and HIV. The latter include articles in The Positive Side, Canadian AIDS News, and monographs available from the AIDS Committee of Toronto (ACT), the Community AIDS Treatment Information Exchange (CATIE), and various other organizations.

Disclaimer:
The material in this publication is for information purposes only. It does not endorse any particular treatment program nor strategy; neither is it intended as medical advice nor as a replacement for medical advice.

©This document is copyrighted by Chester Myers. All materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited.

June 1997
Last modified on: 09/15/2004

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