Zinc and human immunodeficiency virus infection

The importance of zinc in normal immune function - and of its deficiency in immune dysfunction - has led to increased interest in its role in nutrition and immunity in human immunodeficiency virus type 1 (HIV) infection. Zinc deficiency produces reversible immune dysfunction, particularly of T-lymphocyte cell-mediated immunity. In developing countries where zinc deficiency is prevalent, zinc supplementation has been shown to reduce morbidity from respiratory and diarrheal illnesses. The relationship between zinc and HIV infection has not been well delineated. Malabsorption, repeated concurrent infections and increased losses probably increase zinc requirements in HIV infection. In some studies, low plasma zinc levels occur frequently in HIV infection and have predicted disease progression and mortality, suggesting supplementation might be beneficial. However, the finding that zinc binding to specific HIV proteins is essential for HIV function and replication and the association in one observational study of zinc intake with higher rates of HIV progression have raised questions regarding the safety of zinc supplementation among HIV-infected individuals. To date, no randomized, placebo-controlled study of moderate zinc supplementation in HIV infection has been published. We believe that available evidence supports the need for and acceptability of such a trial.