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

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).