The essential trace minerals, immunity, and progression of HIV-1 infection

Studies of the effects of the essential trace minerals on immunity can provide insight into the role of trace element nutrition in HIV-1 infection and its progression to AIDS. Of the 9 essential trace elements, only 4 have been studied in patients with HIV-1 infection. These are copper, iron, selenium, and zinc. Serum copper concentrations are increased considerably in a wide variety of infections, including HIV-1, but there is no evidence of deficiency during infection. HIV infection eventually results in development of the anemia of chronic infection, with low serum iron and transferrin levels and increased serum ferritin. There is considerable evidence for selenium deficiency in HIV-1-infected subjects from various countries that is associated with more rapid disease progression and increased mortality. Declining serum zinc with progression is both a nonspecific marker of infection and evidence of zinc deficiency. Increases in the serum copper/zinc ratio and ferritin and decreases in serum selenium are markers of HIV-1 progression. Paradoxically, supplementation with iron or zinc may increase the rate of progression and supplemental selenium has been associated with increased vaginal shedding of the HIV-1 virus and thus may increase the risk of heterosexual female-to-male transmission. Supplementation of HIV-1-infected patients with Dietary Reference Intake levels of the above essential trace minerals is prudent, but high doses should be discouraged. The combination of antiretroviral drug therapy, a healthy diet, and a low-dose multivitamin/mineral supplement may be especially effective in the treatment of HIV-1-infected patients. (c) 2007 Elsevier Inc. All rights reserved.