Association of Body Mass Index, Waist-Hip Ratio, Zinc, Copper, CD4+ T Cells Count and Viral Load in Early HIV Infection in ART Naïve HIV Infected Adults in Taita Taveta County, Kenya

  • Mwangala L. M. J Voi Research Centre, P.O.BOX 355, Voi, 80300, Kenya Jomo Kenyatta University of Agriculture and Technology, P.O.BOX 355, Nairobi, 80300, Kenya
  • Waihenya R Jomo Kenyatta University of Agriculture and Technology, P.O.BOX 355, Nairobi, 80300, Kenya
  • Mwatha J Kenya Medical Research Institute, P.O.BOX 355, Nairobi, 80300, Kenya Jomo Kenyatta University of Agriculture and Technology, P.O.BOX 355, Nairobi, 80300, Kenya
  • Mwamburi D. M Voi Research Centre, P.O.BOX 355, Voi, 80300, Kenya Tufts University Centre for Global Public Health, 50 Harrison Ave Boston, MA 02111, USA
Keywords: Zinc, Copper, HIV, Immunity, CD4 , ART Naïve, Waist-hip ratio, Body mass index.


During HIV/AIDS micronutrients play a key role in the host defense systems-Micronutrients such as zinc and copper have been implicated to play important roles in immuno-physiologic functions. The aim of the study was to assess the level of zinc and copper among ART naïve HIV positive adults and assess the association with their waist-hip ratio (WHR), body mass index (BMI), viral load and immunity. Descriptive cross-sectional study was conducted in the voluntary counselling and testing centre (VCT) at Comprehensive Care Clinics  in Taita-Taveta County health care services, Coast, Kenya, blood samples obtained from 192 HIV sero-positive individuals, 18 years of age and gender matched healthy controls were analyzed for zinc and copper using atomic absorption spectrophotometer machine. Data were analysed by statistical (SPSS version 21) computer software. The (mean+ SD) of serum copper and zinc were (158.7+51.0µ/dl, 84.3+51.1µ/dl) in patients and (130.5+17.9 µ/dl, 100.3+5.5 µ/dl) in control group, respectively. Serum zinc level was significantly decreased in HIV patients (P value, 0.05) while serum copper level was significantly increased compared to control group. There was significant association between viral load and waist-hip ratio but not body mass index (P < 0.05). Both body mass index and waist-hip ratio were not significantly associated with CD4+T cells in participants at early HIV infection.Serum zinc was significantly associated to waist-hip ratio in participants in early HIV infection. (P < 0.05). This study indicates that zinc and copper levels are altered in patients in early HIV infection with more decreased Zinc level suspected with increased duration of the HIV infection. It also demonstrates that the associated characteristics in early HIV infection are different from studies in late stages. In conclusion, waist-hip ratio has been identified as a more sensitive predictor and nutrition status maker than body mass index in early HIV hence can be a decisive benchmark for monitoring HIV progression. 


[1]. UNAIDS. “UNAIDS Report on Global AIDS Epidemic”. Geneva, Switzerland,2016.
[2]. UNAIDS and WHO. “AIDS epidemic update”. Geneva, Switzerland,WHO, 2016.
[3]. GARPR . “UNAIDS 2016 estimates”.WHO,2016.
[4]. D. Kotler, J.Wang, R. Pierson. “Body composition studies in patients with the acquired immunodeficiency syndrome”. Am J Clin Nutr,vol 42, pp. 1255-65, 1985.
[5]. N. M. Graham, D. Sorensen, N. Odaka, “Relationship of Serum Copper and Zinc levels to HIV-1 Seropositivity and progression to AIDS”. JAIDS,vol 4, pp. 976-980, 1991.
[6]. R. Kupka, G.I. Msamanga, D. Spiegelman, et al. “Selenium status is associated with accelerated HIV disease progression among HIV-1-infected pregnant women in Tanzania”. J Nutr, vol 134, pp.2556–60, 2014.
[7]. P. K. Drain, R. Kupka, F. Mugusi, W.W. Fawzi. “Micronutrients in HIV positive persons receiving highly active antiretroviral therapy”. Amer J Cl Nutr, vol 85, pp. 333 – 345, 2007.
[8]. C.Y. Jones, J.W. Hogan, R. Snyder, et al. “Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort”. Clin Infect Dis, vol 37(suppl):S69–80, 2003.
[9]. I. N. Ibeh, U.S. Nwokenna, S. Onemu and S. Olusoji. “Studies on disease markers in a Nigerian community”. Natl. J. Sci, vol 1, pp. 20-25, 2002.
[10]. I.N. Ibeh and U.S. Nwokenna. “Studies on cations as biomarkers of mammalian immunity: rospects in disease control”. J. Natl. Acad. Adv. Sci, vol 2, pp. 89-109, 2003.
[11]. WHO. “Trace elements in human nutrition and health”. Geneva, Switzerland, 1996.
[12]. B. Amare, K. Tafess, F. Moges, et al. “Levels of Serum Zinc, Copper and Copper/Zinc Ratio in Patients with Diarrhea and HIV Infection in Ethiopia”. Vitam Trace Elem, vol 1, issue 1 ISSN: 2167-0390 VTE, 2011.
[13]. M. K. Baum, G. Shor-Posner, S. Lai, G. Zhang, H. Lai, M. A. Fletcher, et al. “High risk of HIV-related mortality is associated with selenium deficiency”. J Acquir Immune Defic Syndr, vol 15, pp. 370-374, 1997.
[14]. M. L. Failla. “Trace elements and host defense: recent advances and continuing challenges”. J Nutr, vol 133, 1443S–1447S, 2003.
[15]. B. R. Stern, M. Solioz, D. Krewski, P. Aggett, et al. “Copper and Human Health: biochemistry, genetics, and strategies for modeling dose-response relationships”. J Toxicol Environ Health ,B Crit Rev 10, pp. 157–222, 2007
[16]. R. A. Karlstrom, L.R. Levine. “Copper inhibits the protease from human immunodeficiency virus 1 by both cysteine-dependent and cysteine-independent mechanisms”. Natl. Acad. Sci. USA Vol. 88, pp. 5552-5556, Jul 1991.
[17]. T. G. Lohman, A. F. Roche, R. Martorell. “Standardization Reference Manual”. Champaign, IL, Human Kinetics; 1988.
[18]. WHO. “Technical Report Series 894: Obesity: Preventing and managing the global epidemic: report of a WHO consultation”. Geneva, World Health Organization, 2002.
[19]. R. D. Semba, W. T. Caiaffa, N. M. Graham, et al. “Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus infected injection drug users”. J Infect Dis, vol 171, pp 1196–202, 1995.
[20]. M. Neil, Graham, S. Donna, N. Odaka. “Relationship of serum copper and zinc level to HIV seropostive and progression to AIDS”. Journal of Acquired Immunodeficiency syndrome, Raven press, 1991.
[21]. A. Khalili, A. Soudbakhsh, M. Hajiabdolbaghi, S. Dashti-Khavidaki, A. Poorzarel, A. Saeedi and S. Sharififar. “Nutritional status and serum zinc and selenium levels in Iranian HIV infected individuals”. BMC Infectious Diseases, vol 8, pp 165,2008
[22]. A. Malviya, H. Hasan, A. Hussain. “Correlation of CD4+ T cell count with serum Zinc, Copper and Selenium in HIV positive individuals”. The Internet Journal of Epidemiology, Volume 6, Number 2, 2008.
[23]. J. D. Bogden, J. M. Oleske, J. Lloyd, B. D. Louria, F. W. Kemp, K. S. Bruening, et al. “Status of selected nutrients and progression of HIV type 1 infection”. Am J Clin Nutr, vol 72, pp 809–15, 2000.
[24]. M. K. Baum, S. Gail, A. Campa. “Zinc Status in Human Immunodeficiency Virus Infection”. J. Nutr. Vol 130: 1421S—1423S, 2000.
[25]. O. P. García, D. Ronquillo, M. Camacho, et al. “Zinc, vitamin A, and vitamin C status are associated with leptin concentrations and obesity in Mexican women: results from a cross-sectional study”. Nutrition & Metabolism, vol 9, pp 59, 2012.
[26]. M. P. Marrades, J. A. Martinez, M. J. Moreno-Aliaga. “ZAG, a lipid mobilizing adipokine is downregulated in human obesity”. J Physiol Biochem, vol 64(1), pp 61–66, 2008.
[27]. T. Mracek, Q. Ding, T. Tzanavari, K. Kos, J. Pinkney, J. Wilding, et al. “The adipokine zinc-alpha2-glycoprotein (ZAG) is downregulated with fat mass expansion in obesity”. Clin Endocrinol, vol 72(3), pp 334–341, 2009.
[28]. K. Smidt, S. B. Pedersen, B. Brock, O. Schmitz, S. Fisker, J. Bendix, et al. “Zinc transporter genes in human visceral and subcutaneous adipocytes: lean versus obese”. Mol Cell Endocrinol, vol 264(1–2), pp 68–73, 2007.
[29]. P. B. Dos Santos Rocha, A. De Castro Amorim, A. F. de Sousa, S. J. Do Monte, L.C. da Mata Sousa, N. Do Nascimento Nogueira, et al. “Expression of the zinc transporters genes and metallothionein in obese women”. Biol Trace Elem Res, vol 143, pp 603–611, 2011.
[30]. W. Kwiatkowska, B. Knysz, J. Drelichowska-Durawa, M. Czarnecki, J. Gąsiorowski, E. Biłyk, M. Karczewski, W. Witkiewicz, et al. “Overweight, obesity and underweight in HIV infected patients”. Przegl Lek Journal, vol 70(3), pp113-7, 2013.
[31]. S. Dong-Ho, M. K. Baum, S. Sabrina, D. T. Jayaweera, A. Campa, T. Dushyantha, et al. “Relationship of Oxidative Stress with HIV Disease Progression in HIV/HCV Co-infected and HIV Mono-infected Adults in Miami”. Intl Journal of Biosci, Biochem and Bioinformatics, vol. 2, no. 3, pp. 217-222, 2012.