The Role Of Serum Zinc, Copper, Retinol And Alpha-Tocopherol In Modulating Immunity In Hiv And Aids Subjects In Western Kenya.

ABSTRACT

From the early 1980s, scientists continue to debate on HIV as the cause of AIDS with few arguing that AIDS is caused by chemicals, drugs and malnutrition. A nutrition intervention study in Kenya using VIUSIDTM, a recommended daily allowance compliant formulation with respect to ascorbic acid, pyridoxal, folic acid and zinc sulphate, was ineffective in restoring serum zinc levels and immunity of HIV and AIDS subjects in 12 weeks. The purpose of this study was to determine serum micro-nutrient levels, assess blood for immune markers and establish safety of an intervention with VIUSIDTM administered together with mega doses of zinc, selenium and vitamins A, B12, C and E in HIV and AIDS subjects. Ninety subjects were sequentially recruited from VCT centres in western Kenya and clinically examined at baseline and at the 12th week. For intervention, subjects were administered with VIUSIDTM together with citric acid (Arm 1) and VIUSIDTM together with citric acid and with mega doses of zinc, selenium and vitamins A, B12, C and E (Arm 2) for 8 weeks. In both Arms however, administration of VIUSIDTM alone was continued to the 12th week. Venous blood was obtained for determination of micro-nutrient status, viral load, liver function and immune testing. Serum micro-nutrient levels were determined at monthly intervals, serum zinc and copper being determined using a Flame Atomic Absorption Spectrophotometer (FAAS) while retinol and alpha-tocopherol levels were by a High Performance Liquid Chromatograph (HPLC) as respective test kits were used for immunological, virological and liver function tests. Data entry and analysis was by SPSS/PC+ version 11.5, analysis being mainly by parametric and non-parametric methods between and within Arms 1 and 2. Spearman’s Rho correlations were used to establish linkages between measured variables at baseline, during and after intervention. The ninety (90) subjects recruited and randomized into the study were aged 39.0+8.9 years, 70% were female, 47.1% were widows, 22.2% had a history of TB while 54.4 % ate 3 meals a day and 12.2% were confirmed HIV-seronegative despite losing spouses to HIV and AIDS. There were clinical improvements in 74 subjects who completed the study as significant increases in serum zinc levels occurred in both arms by the 4th week, more so in subjects on mega-doses. These declined to near baseline levels at the 12th week, probably suggesting a physiological regulation of the way nutrients were utilized. Although subjects in Arm 2 had significant increase in CD4 cell count (p = 0.007) and near significant viral load reduction (p = 0.104), those in Arm 1 had insignificant increase in CD4 cell count (p = 0.722) but significant decrease in viral load (p = 0.030). Low serum zinc correlated with HIV-seropositivity (p = 0.0001) and high optical desnsity of HIV antibodies (p = 0.002). High serum retinol level at baseline was associated with better management outcomes by the 12th week of supplementation as use of mega-dose supplements had both clinical and immunological benefits and near-significant reduction in viral load. Low doses of micro-nutrients favored viral load reduction, this being in agreement with other studies. Liver function tests of the subjects stayed normal in both study Arms, suggesting the interventions were safe for use. Therefore, use of VIUSIDTM with mega-dose micro-nutrients was safe and more effective than VIUSIDTM only in management of HIV and AIDS subjects. From this study, nutrition has a role in management of HIV and AIDS and probably supports the view that malnutrition is a key factor in HIV and AIDS. Further work should be undertaken to develop and up-scale this intervention with a view to mainstreaming its use in healthcare delivery in Kenya and beyond, especially considering that HIV and AIDS drugs present several challenges, including adverse health effects, resistance and compliance.