Brief Report: Randomized Controlled Trial of Zinc Supplementation for Persistent Diarrhea in Adults With HIV-1 Infection

Department of Epidemiology, University of Washington, Seattle, WA 98104, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 10/2006; 43(2):197-201. DOI: 10.1097/01.qai.0000242446.44285.b5
Source: PubMed


In children, zinc supplementation reduces the incidence and severity of diarrhea.
HIV-infected adults with > or =7 days of diarrhea recruited at 3 tertiary hospitals in Lima, Peru, received a zinc sulfate capsule containing 50 mg of elemental zinc twice daily or an identical placebo for 14 days. Outcomes included persistence of diarrhea at day 14 and time until cessation of diarrhea.
The 81 subjects randomized to zinc and 78 randomized to placebo were comparable at baseline, except for higher prevalences of certain enteric pathogens in the zinc group; complete follow-up rates were 62% and 69%, respectively. Zinc concentrations were consistent with zinc deficiency at follow-up in 94% of placebo recipients and 66% of zinc recipients (P = 0.01). Persistence of diarrhea at day 14 according to follow-up interview (60% for zinc-treated patients and 57.4% for placebo-treated patients) or to patient diary (42.2% vs. 31.9%) did not differ significantly. Adjusting for enteric pathogens and CD4 count, the hazard ratio (HR) for zinc supplementation and cessation of diarrhea (according to the diaries) was 0.91 (95% confidence interval [CI]: 0.50 to 1.64).
Supplemental zinc had no significant effect on the duration or remission of diarrhea in HIV-infected adults.

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    • "No adverse events attributable to zinc supplementation were observed in the included studies. However, indicators of zinc toxicity, such as copper status, were not monitored except in one trial, in which zinc supplementation did not induce copper deficiency (Carcamo et al. 2006). "
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    ABSTRACT: Objectives  To determine the efficacy and safety of zinc supplementary in children, adults and pregnant women with HIV infection. Methods  We conducted a comprehensive search in Medline, Embase, the Cochrane Library, CBM, VIP and CNKI. Only randomized controlled trials conducted subsequent to the introduction of zinc supplementation were included in this systematic review. Two reviewers assessed and extracted data for analysis. Results  Six trials with a total of 1009 participants were included. The findings in this review suggested a benefit of zinc supplementation in reducing opportunistic infection for both adults and children with HIV infection. In terms of increase in zinc level and CD4 counts, however, only adults with HIV infection benefited. For other outcomes, such as viral load, mortality, mother-to-child transmission of HIV and foetal outcomes, zinc supplementation conferred no benefit over placebo. No adverse event related to zinc supplementation was found in all the included trials. Conclusion  Based on the current evidence, zinc supplementation seems to be beneficial in adult patients with HIV infection in some aspects. More research is needed in children and pregnant women. The influence of zinc dose, duration and usage of antiretroviral medicine also requires further investigation.
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