Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Zinc supplementation to HIV-1-infected pregnant women: Effects on maternal anthropometry, viral load, and early mother-to-child transmission

European Journal of Clinical Nutrition volume 60, pages 862–869 (2006)Cite this article

Abstract

Objective:

To examine the effect of zinc supplementation to HIV-1-infected pregnant women on viral load, early mother-to-child transmission of HIV (MTCT), and wasting.

Design:

Double-blind placebo-controlled randomized clinical trial.

Setting:

Antenatal clinic in Dar es Salaam, Tanzania.

Subjects:

Four hundred HIV-1-infected pregnant women.

Methods:

Women 12–27 weeks of gestation were randomly assigned to receive a daily oral dose of 25 mg zinc or placebo from the day of the first prenatal visit until 6 weeks postdelivery. Weight and mid-upper arm circumference (MUAC) were measured monthly. HIV status of the babies was assessed at birth and at 6 weeks postpartum. Viral load was assessed in a random sample of 100 women at baseline and at the end of the study.

Results:

Zinc had no effects on maternal viral load or early MTCT. Supplementation was related to a significant threefold increase in the risk of wasting (reaching a MUAC value <22 cm) during an average 22 weeks of observation (RR=2.7, 95%CI=1.1, 6.4, P=0.03), and to a 4 mm decline in MUAC during the second trimester (P=0.02).

Conclusions:

Zinc supplementation to HIV-infected pregnant women offers no benefits on viral load or MTCT. The clinical relevance of an apparent decrease in MUAC associated with zinc supplementation is yet to be ascertained. These findings together with the lack of effect on fetal outcomes (reported previously) do not provide support for the addition of zinc supplements to the standard of prenatal care among HIV-infected women.

Sponsorship:

The US National Institute of Child Health and Human Development (NICHD R01 32257).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Acharyya S, Ladner KJ, Nelsen LL, Damrauer J, Reiser PJ, Swoap S et al. (2004). Cancer cachexia is regulated by selective targeting of skeletal muscle gene products. J Clin Invest 114, 370–378.

    Article  CAS  Google Scholar 

  • Baum M, Cassetti L, Bonvehi P, Shor-Posner G, Lu Y, Sauberlich H (1994). Inadequate dietary intake and altered nutrition status in early HIV-1 infection. Nutrition 10, 16–20.

    CAS  PubMed  Google Scholar 

  • Baum MK, Campa A, Lai S, Lai H, Page JB (2003). Zinc status in human immunodeficiency virus type 1 infection and illicit drug use. Clin Infect Dis 37 (Suppl 2), 117S–123S.

    Article  Google Scholar 

  • Baum MK, Shor-Posner G, Lai S, Zhang G, Lai H, Fletcher MA et al. (1997a). High risk of HIV-related mortality is associated with selenium deficiency. J Acquired Immune Defic Syndr Hum Retrovirol 15, 370–374.

    Article  CAS  Google Scholar 

  • Baum MK, Shor-Posner G, Lu Y, Rosner B, Sauberlich HE, Fletcher MA et al. (1995). Micronutrients and HIV-1 disease progression. AIDS 9, 1051–1056.

    Article  CAS  Google Scholar 

  • Baum MK, Shor-Posner G, Zhang G, Lai H, Quesada JA, Campa A et al. (1997b). HIV-1 infection in women is associated with severe nutritional deficiencies. J Acquired Immune Defic Syndr Hum Retrovirol 16, 272–278.

    Article  CAS  Google Scholar 

  • Beach RS, Mantero-Atienza E, Shor-Posner G, Javier JJ, Szapocznik J, Morgan R et al. (1992). Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS 6, 701–708.

    Article  CAS  Google Scholar 

  • Beck FW, Prasad AS, Kaplan J, Fitzgerald JT, Brewer GJ (1997). Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. Am J Physiol 272, E1002–E1007.

    CAS  PubMed  Google Scholar 

  • Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A et al. (2000). Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr 72, 1516–1522.

    Article  CAS  Google Scholar 

  • Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A et al. (1999). Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. J Pediatr 135, 689–697.

    Article  CAS  Google Scholar 

  • Bobat R, Coovadia H, Stephen C, Naidoo KL, McKerrow N, Black RE et al. (2005). Safety and efficacy of zinc supplementation for children with HIV-1 infection in South Africa: a randomised double-blind placebo-controlled trial. Lancet 366, 1862–1867.

    Article  CAS  Google Scholar 

  • Bogden JD, Baker H, Frank O, Perez G, Kemp F, Bruening K et al. (1990). Micronutrient status and human immunodeficiency virus (HIV) infection. Ann NY Acad Sci 587, 189–195.

    Article  CAS  Google Scholar 

  • Bogden JD, Kemp FW, Han S, Li W, Bruening K, Denny T et al. (2000). Status of selected nutrients and progression of human immunodeficiency virus type 1 infection. Am J Clin Nutr 72, 809–815.

    Article  CAS  Google Scholar 

  • Brown KH (1998). Effect of infections on plasma zinc concentration and implications for zinc status assessment in low-income countries. Am J Clin Nutr 68, 425S–429S.

    Article  CAS  Google Scholar 

  • Diggle PJ, Heagerty P, Liang K, Zeger S (2002). Analysis of Longitudinal Data. Oxford University Press: Oxford.

    Google Scholar 

  • Fawzi WW, Msamanga G, Hunter D, Urassa E, Rengifo B, Mwakagile D et al. (2000). Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania. J Acquir Immune Defic Syndr 23, 246–254.

    Article  CAS  Google Scholar 

  • Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, McGrath N, Mwakagile D et al. (1998). Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 351, 1477–1482.

    Article  CAS  Google Scholar 

  • Fawzi WW, Msamanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E et al. (2004). A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 351, 23–32.

    Article  CAS  Google Scholar 

  • Fawzi WW, Villamor E, Msamanga GI, Antelman G, Aboud S, Urassa W et al. (2005). Trial of zinc supplements in relation to pregnancy outcomes, hematologic indicators, and T cell counts among HIV-1-infected women in Tanzania. Am J Clin Nutr 81, 161–167.

    Article  CAS  Google Scholar 

  • Graham NM, Sorensen D, Odaka N, Brookmeyer R, Chan D, Willett WC et al. (1991). Relationship of serum copper and zinc levels to HIV-1 seropositivity and progression to AIDS. J Acquir Immune Defic Syndr 4, 976–980.

    CAS  PubMed  Google Scholar 

  • Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C et al. (1999). Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354, 795–802.

    Article  CAS  Google Scholar 

  • International Zinc Nutrition Consultative Group (IZiNCG) (2004). Assessment of the risk of zinc deficiency in populations. Food Nutr Bull 25, 130S–162S.

  • James WPT, Mascie-Taylor GCN, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A (1994). The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. Eur J Clin Nutr 48, 883–894.

    CAS  PubMed  Google Scholar 

  • Jiamton S, Pepin J, Suttent R, Filteau S, Mahakkanukrauh B, Hanshaoworakul W et al. (2003). A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS 17, 2461–2469.

    Article  CAS  Google Scholar 

  • Kelly P, Musonda R, Kafwembe E, Kaetano L, Keane E, Farthing M (1999). Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: a randomized controlled trial. AIDS 13, 495–500.

    Article  CAS  Google Scholar 

  • Koch J, Neal EA, Schlott MJ, Garcia-Shelton YL, Chan MF, Weaver KE et al. (1996). Zinc levels and infections in hospitalized patients with AIDS. Nutrition 12, 515–518.

    Article  CAS  Google Scholar 

  • Lindan CP, Allen S, Serufilira A, Lifson AR, Van de Perre P, Chen-Rundle A et al. (1992). Predictors of mortality among HIV-infected women in Kigali, Rwanda. Ann Intern Med 116, 320–328.

    Article  CAS  Google Scholar 

  • Mantzoros CS, Prasad AS, Beck FW, Grabowski S, Kaplan J, Adair C et al. (1998). Zinc may regulate serum leptin concentrations in humans. J Am Coll Nutr 17, 270–275.

    Article  CAS  Google Scholar 

  • Mocchegiani E, Veccia S, Ancarani F, Scalise G, Fabris N (1995). Benefit of oral zinc supplementation as an adjunct to zidovudine (AZT) therapy against opportunistic infections in AIDS. Int J Immunopharmacol 17, 719–727.

    Article  CAS  Google Scholar 

  • Ramboarina S, Druillennec S, Morellet N, Bouaziz S, Roques BP (2004). Target specificity of human immunodeficiency virus type 1 NCp7 requires an intact conformation of its CCHC N-terminal zinc finger. J Virol 78, 6682–6687.

    Article  CAS  Google Scholar 

  • Shankar AH, Prasad AS (1998). Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr 68, 447S–463S.

    Article  CAS  Google Scholar 

  • Tamura T, Goldenberg RL (1996). Zinc nutriture and pregnancy outcome. Nutr Res 16, 139–181.

    Article  CAS  Google Scholar 

  • Tanchou V, Decimo D, Pechoux C, Lener D, Rogemond V, Berthoux L et al. (1998). Role of the N-terminal zinc finger of human immunodeficiency virus type 1 nucleocapsid protein in virus structure and replication. J Virol 72, 4442–4447.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Tang AM, Graham NMH, Kirby AJ, McCall AD, Willett WC, Saah AJ (1993). Dietary micronutrient intake and risk progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men. Am J Epidemiol 138, 1–15.

    Article  Google Scholar 

  • Tang AM, Graham NMH, Saah AJ (1996). Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol 143, 1244–1256.

    Article  CAS  Google Scholar 

  • Villamor E, Msamanga G, Spiegelman D, Antelman G, Hunter DJ, Peterson KE et al. (2002a). Effect of multivitamin and vitamin A supplements on weight gain during pregnancy among HIV-1 infected women. Am J Clin Nutr 76, 1082–1090.

    Article  CAS  Google Scholar 

  • Villamor E, Msamanga G, Spiegelman D, Coley J, Hunter DJ, Peterson KE et al. (2002b). HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy. Eur J Clin Nutr 56, 415–424.

    Article  CAS  Google Scholar 

  • White H (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 48, 817–830.

    Article  Google Scholar 

  • Zarkesh-Esfahani H, Pockley G, Metcalfe RA, Bidlingmaier M, Wu Z, Ajami A et al. (2001). High-dose leptin activates human leukocytes via receptor expression on monocytes. J Immunol 167, 4593–4599.

    Article  CAS  Google Scholar 

  • Zijenah LS, Moulton LH, Iliff P, Nathoo K, Munjoma MW, Mutasa K et al. (2004). Timing of mother-to-child transmission of HIV-1 and infant mortality in the first 6 months of life in Harare, Zimbabwe. Aids 18, 273–280.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the mothers and children, field teams including nurses, physicians, midwives, supervisors, lab staff, and the administrative staff who made the study possible. We thank the authorities at Muhimbili University College of Health Sciences, Muhimbili National Hospital, the City of Dar es Salaam Regional Health Authority, and the Tanzanian National AIDS Control Program for their institutional support. This study was supported by the National Institute of Child Health and Human Development (NICHD R01 32257).

Author information

Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    E Villamor, R Kupka & W W Fawzi

  2. Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

    S Aboud & W Urassa

  3. Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA

    I N Koulinska & B Chaplin

  4. Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

    G Msamanga

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    W W Fawzi

Authors
  1. E Villamor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Aboud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I N Koulinska
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Kupka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W Urassa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B Chaplin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G Msamanga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W W Fawzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Villamor.

Additional information

Guarantor: E Villamor.

Contributors: EV carried out the data analyses, interpreted the results, and wrote the initial draft of the manuscript. SA, INK, WU, and BC carried out laboratory analyses and contributed to the interpretation of results. EV, SA, RK, WU, and GM participated in the study design and implementation in the field. WWF was Principal Investigator of the study. All authors contributed to the final version of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Villamor, E., Aboud, S., Koulinska, I. et al. Zinc supplementation to HIV-1-infected pregnant women: Effects on maternal anthropometry, viral load, and early mother-to-child transmission. Eur J Clin Nutr 60, 862–869 (2006). https://doi.org/10.1038/sj.ejcn.1602391

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602391

Keywords

This article is cited by

Search

Advanced search

Quick links