Zinc Supplements Safe for HIV-Infected Children

Supplements Reduce Frequency of Diarrhea Without Adverse Impact on Viral Load

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 November 26, 2005, 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, MD, MPH, senior author of the study and an assistant professor in the Bloomberg School of Public Health’s Department of Epidemiology.

The researchers completed a randomized, double-bind, 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,” said Moss.

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, MD, MPH, chair of the Bloomberg School of Public Health’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.