International Journal of Community Medicine and Public Health

John S et al. Int J Community Med Public Health. 2024 Oct;11(10):4050-4054

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Systematic Review

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20242891

Effectiveness of nutritional intervention on immunity among people living with HIV/AIDS: a systematic review

Stephen John1*, Dileep S. Natekar2

1Department of Community Health Nursing, GIMS Govt. College of Nursing, Gadag, Karnataka, India

2Department of Community Health Nursing, Sajjalashree Institute of Nursing Sciences, Bagalkot, Karnataka, India

Received: 08 June 2024

Revised: 21 September 2024

Accepted: 23 September 2024

*Correspondence:

Dr. Stephen John,

E-mail: stevenfantabulous@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

A huge progress is made in the treatment modality of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). To develop cure or enhance immunity of people living with HIV/AIDS (PLHIV), major researches are being conducted across the globe. Nutritional interventions are experimented widely over a period of time in improving immunity among PLHIV but concrete evidence in this regard is doubted still. This study aimed to assess the effectiveness of selected nutritional interventions (zinc) on immunity among PLHIV. The search methods and selection criteria include randomized controlled trial on nutritional interventions, specifically; effect of zinc on immune status of PLHIV was conducted. An extensive search from databases like ProQuest, PubMed, Cochrane and Science Direct was conducted from 28/04/2022 to 28/05/ 2022, a total of 05 studies were included after screening with PEDro scale and preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting to derive at a consensus on effect of zinc on immune status of PLHIV. Three reviewers independently screened and selected the trials for inclusion. The cumulative sample size from all the studies was 1329. As studies included were diverse meta-analysis was not possible. Four studies revealed that zinc supplementation was not effective in enhancing immune system of PLHIV whereas another 1 study showed that zinc supplementation is effective in boosting immune level among PLHIV. Zinc supplementation is beneficial and safe among PLHIV as it boosts immunity but further investigation is needed to generalize the findings.

Keywords: HIV, AIDS, PLHIV, Zinc, Immunity, CD4 cell count, Nutrition

INTRODUCTION

A huge progress is made in the treatment modality of HIV/AIDS. Initially, in 1980s when this global pandemic appeared on the face of the world, it had no answer to it but today we are having life savings drugs to control this syndrome.1

Now is the time to take a step further by treating it completely as curable disease or preventable syndrome by the means of apt health interventions. In this regard, major attempts and researches are being conducted across the globe. Nutritional interventions are also experimented widely over a period of time in improving immune status among PLHIV but concrete evidence in this regard is doubted still. Nutritional factors play an important role in enhancing immunity and their deficiency had contributed towards compromised immunity in the PLHIV and in particularly with zinc.2

Zinc being a trace element is still an immune booster. The most effective way to deal with HIV/AIDS is by complementing anti-retroviral therapy with zinc. In this regard to investigate the effectiveness of zinc, this study was conducted.3

METHODS

The objective of the study was to assess the effectiveness of selected nutritional intervention (zinc) on immunity among PLHIV. Following is the population, intervention, comparison and outcome (PICO) description.

Table 1: PICO description.
Table reproduced from source PDF page 2

Criteria for selection of studies

The literature search and review were conducted from 28/04/2022 to 28/05/2022 and PEDro scale was used to determine the quality of the study. Following are details.

Table 2: Criteria for selection of studies.
Table reproduced from source PDF page 2

Search methods for identification of studies

An extensive search was carried out, the most was from the electronic data base, and the various search strategies were adapted which included: Online databases like PubMed central, Science Direct and ProQuest. The Cochrane library-Cochrane database of systematic reviews and Cochrane central register of controlled trials (central).

The search strategy included the key words and the mesh terms related to PICO of the intended work, like- “Humans" "viruses" "HIV", "retroviridae"

"HIVinfections""sexually transmitted diseases", "communicable diseases" "acquired immunodeficiency syndrome" "sarcoma, kaposi", "muscular atrophy" "HIV wasting syndrome" "nutrients", "micro nutrients" "trace elements" "minerals", "zinc" "nutritional support" "nutrition therapy", "diet therapy" "nutritional status" "nutritional sciences", "immunity" "immune system" "antigens", "HIV antibodies" "cd4-positive t-lymphocytes" viral load" and "adaptive immunity “immunity, humoral."

All the acquired studies through this search were subjected to quality check by using PEDro scale in an intention to identify potential studies that could be considered for inclusion. PEDro scale included 11 items (yes/no). a score on PEDro scale <4 was considered to be weak, 5-6 was considered to be fair, 6-8 was considered as good and 08-10 was considered as optimal Out of 213 studies only 06 manuscripts were taken for recommendation as per the inclusion criteria.5

The details of PRISMA are given below.6

Figure 1: Prisma flow diagram. | Records identified through database searching (n = 213) Screening Included Eligibility Identification Additional records identified through other sources (n = 00) Records after duplicates removed (n = 05) Records screened (208) (TITLE + METHODOLOGY SCREENING)(n =208) Records excluded (n =187) Full-text articles assessed for eligibility (n =21 ) Full-text articles excluded, with reasons, (n = 16 ) NO CLEAR INFERENCE. Studies included in qualitative synthesis (n = 05 )
Figure 1: Prisma flow diagram.
Table 3: Studies included in this systematic review.
Table reproduced from source PDF page 3

Method of data collection and analysis

The titles and abstracts of the acquired studies were reviewed by the authors. The relevance to the topic was determined; all the related articles were subjected to full text review by the author. On review of full text, the author decided either to include or not to include the study based on inclusion and exclusion criteria.

Inclusion criteria

RCTs on nutritional intervention(zinc) for improving immunity among PLHIV were included.

Exclusion criteria

Pre experimental studies on nutritional interventions for improving immunity among PLHIV, case reports on nutritional interventions for improving immunity among PLHIV. Other non-experimental or qualitative studies on nutritional interventions for improving immunity among PLHIV were excluded.

RESULTS

In the Table 3 finding of the study shows that out of 5 studies 4 studies revealed that zinc supplementation was not effective in enhancing immune system of PLHIV whereas another 1 study showed that zinc supplementation is effective in boosting immune level among PLHIV.

DISCUSSION

In communities with high incidence and prevalence of HIV/AIDS, the mortality and morbidity rate can be seen on high. Anti-retroviral therapy (ART) is found to be effective in bringing down the mortality rate among PLHIV. In combination to ART, a complementary nutrient therapy like administration of micro nutrients and macro nutrients to avoid muscle wasting and strengthen immune system can significantly contribute to elevate the effectiveness of ART. In addition, zinc supplementation, in minimal volume for a longer period of time may improve the immune status in patients with HIV/AIDS.12-15

Zinc, despite being a trace element plays a central role in immune system and zinc deficient person has increased susceptibility to pathogens/infections. The immune function of zinc starts with skin barrier and ends up to activation of T-Lymphocytes. It is essential for development and functioning of cells mediating nonspecific immunity like neutrophils. This review explored the biology of zinc in relation to immune system and takes a step further to provided basis to draw a consensus on credibility of immune system in zinc deficiency or zinc supplementation.16

Our review identified various studies RCTs and other than a RCT those contributed to the evidence base supporting the effectiveness of zinc in enhancing the immunity of and individual but only RCTs were included in this study to maintain homogeneity. Few RCTs showed no conclusive evidence of effectiveness of zinc in enhancing the immunity.17-19

Therefore, to further explore, we need to investigate effectiveness of zinc in relation to minimum dose and maximum duration. Given the features of zinc, it is indispensable to explore as it is cost effective, minimum side effects and huge upside potential.20,21

CONCLUSION

Zinc appears to have a promising property in complementing and strengthening the ART in treatment of HIV/AIDS. The challenge to the scientific community is that it has to be rigorously tested over a large sample size to generalize the finding.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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