Zinc Not Impactful on HIV/AIDs Mortality Among Heavy Alcohol Users

Zinc supplementation may have a marginal effect on mortality among people living with HIV/AIDS (PLWHA) who are also heavy users of alcohol, according to new research.

Heavy alcohol use is common in PLWHA, as is zinc deficiency. These factors, along with HIV infection itself, can lead to reductions in intestinal wall integrity and then microbial translocation and inflammation. Ultimately, patients could face a higher risk of mortality and cardiovascular disease, as well as faster disease progression.

Writing in the journal JAMA Network Open, corresponding author Matthew S. Freiberg, MD, MSc, of Vanderbilt University Medical Center, and colleagues, noted that the main approach taken to counteract the problems of heavy alcohol use in PLWHA is to encourage cessation of smoking. That approach can be effective, they wrote, but it’s not uniformly so.

Zinc supplementation has been linked with lower biomarkers of inflammation, which is an indirect measure of microbial translocation. Zinc also has the benefit of being widely available and easily accessible for most patients. Freiberg and colleagues therefore wondered if it might be an effective tool to lower the risks of mortality and heart disease if given to PLWHA who use alcohol heavily.

The investigators constructed a double-blind, placebo-controlled randomized clinical trial of 254 participants recruited from HIV and addiction care sites in St. Petersburg, Russia. Each of the patients had documented HIV infection, had not undergone antiretroviral therapy at baseline, and reported heavy alcohol consumption within the past 30 days. The patients were recruited from 2013-2015 and the data were analyzed between February 2017-February 2020.

Patients in the study were given pharmacy-grade zinc gluconate supplements daily for 18 months; men were given doses of 15 mg and women were given 12 mg. The control group was given a placebo.

Freiberg and colleagues used the Veterans Aging Cohort Study Index to measure mortality risk. They also measured several secondary outcomes, including CD4 count, cardiovascular disease risk, and changes in inflammatory or microbial translocation biomarkers at 18 months.

The investigators found zinc supplementation did not have a statistically significant impact on VACS Index score or on any of the secondary outcomes.

Still, Freiberg and colleagues said the findings were clinically meaningful, even if they fell short of statistical significance. Those in the zinc supplementation group had a slower increase in VACS score (0.49 compared to 5.5 in the placebo group). Translated to mortality risk, that means those on zinc saw their mortality risk rise just 2% compared to 20% for the placebo group over the 18 months. Moreover, the data suggested adherence to the zinc protocol made a significant difference.

“When restricting analyses to those who were adherent to the protocol, participants in the zinc group had statistically significant increases in VACS Index scores,” the investigators said.

The investigators reported a higher number of deaths in the zinc group, though that also did not reach statistical significance.

In conclusion, the investigators suggested that if taken as prescribed, zinc supplementation may have reduced mortality risk in this population. They suggest that a larger trial is warranted to fully understand if zinc supplementation is of benefit to these patients.