Plasma Zinc, Copper, Copper:Zinc Ratio, and Survival in a Cohort of HIV-1–Infected Homosexual Men:

Nutritional Status of Adult People Living with HIV: A Narrative Review

BACKGROUND

The interaction between HIV infection, nutrition and immune system functioning is intricate, leading, in many cases, to a cycle of poor health outcomes. Despite the widespread use of highly active antiretroviral therapy (HAART) since the late 1990s and the concomitant increase in the life expectancy of people living with HIV (PLHIV), malnutrition and HIV-associated wasting continue to pose significant challenges, particularly in developing countries. Additionally, metabolic adverse effects associated with HAART, such as alterations in bone and lipid metabolism, as well as the impact on cardiovascular health, add further complexity to patient care.

METHODS

We conducted a comprehensive literature review of relevant studies involving adults diagnosed with HIV. The studies, published between 2000 and 2023, were identified using the Medline/PubMed, Scopus and Google Scholar databases.

RESULTS

Accumulating evidence in the literature indicates that careful monitoring and appropriate nutritional interventions can significantly enhance clinical outcomes in malnourished HIV-positive persons. The importance of addressing the prevalent deficiencies in certain micronutrients discussed in many of the studies is clearly underlined. However, challenges remain, particularly in low-income settings, where limited resources and infrastructure can impede effective implementation.

CONCLUSIONS

There are critical research gaps with regard to the interaction between ART and nutrition, as well as the development of tailored nutritional approaches that aim to improve patient outcomes. Future research directions and policy strategies should focus on the development of sustainable programmes aimed at enhancing the quality of life for PLHIV.

Serum copper-to-zinc ratio and risk of incident pneumonia in caucasian men: a prospective cohort study

Serum copper (Cu) and zinc (Zn), essential micronutrients that have important immunomodulatory and antimicrobial properties, are biomarkers of ageing. Serum Cu/Zn-ratio may be a more reliable marker for age-related degenerative conditions compared with serum Cu or Zn alone. We aimed to assess the association between Cu/Zn-ratio and the risk of incident pneumonia in a prospective cohort study. Serum levels of Cu and Zn were measured at baseline using atomic absorption spectrometry in 2503 men aged 42–61 years in the Kuopio Ischemic Heart Disease prospective cohort study. Hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident pneumonia using Cox regression models. A total of 599 cases of pneumonia occurred during a median follow-up of 26.1 years. Serum Cu/Zn-ratio and Cu were each linearly associated with incident pneumonia. A unit increase in Cu/Zn-ratio was associated with an increased risk of pneumonia in analysis adjusted for potential confounders including C-reactive protein (HR 1.65; 95% CI 1.17–2.33). The corresponding adjusted HR (95% CI) was 2.04 (1.22–3.40) for serum Cu. The association between serum Zn and pneumonia was curvilinear. Compared to the bottom tertile of Zn, the multivariable adjusted HRs (95% CIs) for incident pneumonia were 0.68 (0.55–0.83) and 0.96 (0.79–1.16) for the middle and top tertiles of Zn, respectively. Further analysis in the same participants showed that Cu/Zn-ratio might be a stronger risk indicator for pneumonia than serum C-reactive protein. In middle-aged and older Finnish men, increased serum Cu/Zn-ratio and Cu concentrations are each linearly associated with an increased risk of incident pneumonia.

Evaluation of iron, ferritin, copper, and ceruloplasmin along with proviral load in human T lymphotropic virus type 1-associated myelopathy

Human T-cell lymphotropic virus type 1 (HTLV-1) infection can cause HTLV-I-associated myelopathy (HAM). In this study, we evaluated the levels of serum iron, ferritin, copper, and ceruloplasmin, and their correlations with HTLV-1 proviral load (PVL) and standard indices of HAM severity. In total, 114 subjects were recruited in this cross sectional study in Qaem Hospital, Mashhad, Iran between 2017 and 2018, including 36 HAM and 32 asymptomatic cases (ACs) and 46 healthy people (HSs). The clinical examination and evaluation of serum levels of biochemical factors and proviral load were performed. The PVL in HAM and ACs were 1835.49 ± 382.81 and 280.97 ± 67.41 copies/104 PBMCs, which statistically differed. Significant differences were also observed in plasma levels of iron, copper, and ceruloplasmin, among the three groups, while ferritin level was not considerably different. For HAM severity, the mean Osame motor disability scale (OMDS) and overactive bladder-validated-8-questionnaire (OABV-8) scores were 4.97 ± 0.38 and 15.75 ± 0.83, respectively, that had no significant correlations with the biochemical variables. Even though the studied elements in HAM group did not affect the severity of the disease, the levels of copper and ceruloplasmin might be determinants of the development and progression of HAM, as they are shown to play role in progression of other neurological diseases.

Pan-retroviral Nucleocapsid-Mediated Phase Separation Regulates Genomic RNA Positioning and Trafficking

The duality of liquid-liquid phase separation (LLPS) of cellular components into membraneless organelles defines the nucleation of both normal and disease processes including stress granule (SG) assembly. From mounting evidence of LLPS utility by viruses, we discover that HIV-1 nucleocapsid (NC) protein condenses into zinc-finger (ZnF)-dependent LLPSs that are dynamically influenced by cytosolic factors. ZnF-dependent and Zinc (Zn2+)-chelation-sensitive NC-LLPS are formed in live cells. NC-Zn2+ ejection reverses the HIV-1 blockade on SG assembly, inhibits NC-SG assembly, disrupts NC/Gag-genomic RNA (vRNA) ribonucleoprotein complexes, and causes nuclear sequestration of NC and the vRNA, inhibiting Gag expression and virus release. NC ZnF mutagenesis eliminates the HIV-1 blockade of SG assembly and repositions vRNA to SGs. We find that NC-mediated, Zn2+-coordinated phase separation is conserved among diverse retrovirus subfamilies, illustrating that this exquisitely evolved Zn2+-dependent feature of virus replication represents a critical target for pan-antiretroviral therapies.

Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus

OBJECTIVES

Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals.

METHODS

The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations.

RESULTS

Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1β, interleukin-6, and tumor necrosis factor-α) was found.

CONCLUSION

Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.

A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok

OBJECTIVES

To examine the impact of high-dose multiple micronutrient supplementation on survival and disease progression among HIV-infected individuals in Thailand.

DESIGN

Randomized placebo-controlled trial.

METHODS

Four-hundred and eighty-one HIV-infected men and women living in and around Bangkok with CD4 cell counts in the range 50 x 10(6)- 550 x 10(6)/l were randomized to receive micronutrients or placebo for a period of 48 weeks. Trial participants were examined clinically 12-weekly and tested for CD4 cell count 24-weekly. A subset were tested for HIV plasma viral load at 48 weeks.

RESULTS

Seventy-nine (16%) trial participants were lost to follow-up and 23 (5%) died. The death rate was lower in the micronutrients arm with the mortality hazard ratios [95% confidence interval (CI)] of 0.53 (0.22-1.25; P = 0.1) overall and 0.37 (0.13-1.06; P = 0.052) and 0.26 (0.07-0.97; P = 0.03) among those with CD4 cell counts < 200 x 10(6)/l and < 100 x 10(6)/l respectively. There was no impact on CD4 cell count or plasma viral load.

CONCLUSIONS

Multiple micronutrient supplementation may enhance the survival of HIV-infected individuals with CD4 cell counts < 200 x 10(6)/l. This could have important public health implications in the developing world where access to antiretrovirals remains poor. The clinical findings need to be reproduced in other settings and the mechanism, which appears to be independent of change in CD4 cell count, merits further investigation.