The combination of heavy alcohol consumption and HIV infection is associated with increased mortality, HIV disease progression, acute myocardial infarction (AMI) and a proinflammatory state characterized by increased biomarker levels of inflammation. Heavy alcohol use and HIV infection are both causes of microbial translocation, the process by which bacterial products from the gastrointestinal (GI) tract leak across the GI membrane to the portal circulation. Microbial translocation causes immune activation leading to end organ damage. Alcohol can cause microbial translocation via zinc deficiency. Zinc deficiency is common among HIV+ heavy drinkers and linked to high mortality rates. Zinc supplementation is affordable, available, does not interfere with ART, and has minimal adverse drug reactions. In animal models zinc reduces ethanol associated microbial translocation. In human studies zinc slows HIV disease progression and reduces levels of inflammatory biomarkers which are strongly linked to mortality. Given zinc's potential efficacy we propose to conduct Zinc for INflammation and Chronic disease in HIV (ZINC HIV), a double-blinded randomized controlled trial to assess the efficacy of zinc supplementation vs. placebo among 250 HIV+ Russians, who are ART-naive at enrollment and have a recent history of heavy drinking. We will recruit most of our participants from the Russia cohort within the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium study.
Our specific aims will test the efficacy of zinc supplementation, compared to placebo to (1) improve markers of mortality as measured by the VACS index;(2) slow HIV disease progression as measured by CD4 cell count;(3) improve markers of AMI risk as measured by the Reynolds risk score;and (4) lower levels of microbial translocation and inflammation as measured by serum biomarkers. We hypothesize that as compared with placebo, patients receiving zinc supplementation will have significantly lower AMI and mortality risk as measured by the VACS index and Reynolds risk scores;higher CD4 cell counts;lower levels of biomarkers for microbial translocation and inflammation. Importantly, if our hypotheses are true, zinc supplementation could ultimately become a standard adjunctive therapy complementing alcohol interventions among HIV+ persons even in resource limited environments.
The combination of heavy alcohol consumption and HIV infection results in serious health problems and an increased risk of death. Although it is not exactly clear how alcohol and HIV do this, inflammation appears to play an important role. Zinc supplementation has anti-inflammatory properties. This study is designed to see if giving zinc supplementation to HIV infected people who are heavy drinkers reduces the risk of serious health problems and death.
|Forman, Leah S; Patts, Gregory J; Coleman, Sharon M et al. (2018) Use of an android phone application for automated text messages in international settings: A case study in an HIV clinical trial in St. Petersburg, Russia. Clin Trials 15:36-43|
|Wagman, Jennifer A; Samet, Jeffrey H; Cheng, Debbie M et al. (2018) Female Gender and HIV Transmission Risk Behaviors Among People Living with HIV Who Have Ever Used Injection Drugs in St. Petersburg, Russia. AIDS Behav 22:2830-2839|
|Coleman, Sharon M; Gnatienko, Natalia; Lloyd-Travaglini, Christine A et al. (2018) False-positive HIV diagnoses: lessons from Ugandan and Russian research cohorts. HIV Clin Trials 19:15-22|
|Gnatienko, Natalia; Freiberg, Matthew S; Blokhina, Elena et al. (2018) Design of a randomized controlled trial of zinc supplementation to improve markers of mortality and HIV disease progression in HIV-positive drinkers in St. Petersburg, Russia. HIV Clin Trials 19:101-111|
|Idrisov, Bulat; Lunze, Karsten; Cheng, Debbie M et al. (2017) Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia. Addict Sci Clin Pract 12:30|
|Asiimwe, Stephen B; Fatch, Robin; Patts, Gregory et al. (2017) Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda. AIDS Behav 21:204-215|
|Idrisov, Bulat; Lunze, Karsten; Cheng, Debbie M et al. (2017) Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART. AIDS Behav 21:3486-3495|
|Tsui, Judith I; Cheng, Debbie M; Coleman, Sharon M et al. (2017) Pain and Risk Behaviors Among HIV-Infected Persons in St. Petersburg, Russia. AIDS Behav 21:1775-1781|
|Edelman, E Jennifer; Lunze, Karsten; Cheng, Debbie M et al. (2017) HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking. AIDS Behav 21:2618-2627|
|Patts, Gregory J; Cheng, Debbie M; Emenyonu, Nneka et al. (2017) Alcohol Use and Food Insecurity Among People Living with HIV in Mbarara, Uganda and St. Petersburg, Russia. AIDS Behav 21:724-733|
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