A randomised controlled trial of oral zinc on the immune response to tuberculosis in HIV-infected patients.
METHODS
The National HIV Unit, Singapore.


OBJECTIVE
To test whether zinc supplementation improves the immune response to tuberculosis in HIV-positive patients.


METHODS
A double-blind, randomised, placebo-controlled trial of 28 days of oral zinc sulphate (50 mg of elemental zinc) or placebo in stable adult HIV-positive patients receiving antiretroviral therapy with a CD4 count <200 cells/microl.


METHODS
IFN-gamma response to mycobacterial antigen stimulation, CD4/8 cell count, lymphocyte subsets, T-cell receptor excision circle (TREC) levels and viral load were measured at baseline and day 28.


RESULTS
Thirty-two patients received zinc and 34 placebo. There was no significant change in the IFN-gamma response to human PPD stimulation in the zinc or placebo groups (placebo baseline: 0.42 +/- 1.03, day 28: 0.84 +/- 1.21 IU/ml, zinc baseline: 1.26 +/- 2.41, day 28: 1.39 +/- 1.88 IU/ml, P = 0.31 between groups), nor any of the other mycobacterial antigens tested. There were no changes in absolute CD4/8 cell levels or other lymphocyte subsets, TREC or viral load. Baseline zinc levels were normal in 62/66 (93.9%) patients.


CONCLUSIONS
We found no evidence for recommending pharmacological supplementation with oral zinc in HIV-positive patients without zinc deficiency.
Green
J A
JA
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore. justin.green@imperial.ac.uk
Lewin
S R
SR
Wightman
F
F
Lee
M
M
Ravindran
T S
TS
Paton
N I
NI
D000284:Administration, Oral; D000328:Adult; D000917:Antibody Formation / Q000187:drug effects*; D000942:Antigens, Bacterial; D016516:CD4-CD8 Ratio; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000276:immunology*; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D011948:Receptors, Antigen, T-Cell / Q000097:blood; D019562:Viral Load; D019287:Zinc Sulfate / Q000494:pharmacology*
D000942:Antigens, Bacterial; D011948:Receptors, Antigen, T-Cell; D019287:Zinc Sulfate; D007371:Interferon-gamma