Uncorrected Proof Shiraz E-Med J. 2022 December; 23(12):e126471. Published online 2022 December 13. https://doi.org/10.5812/semj-126471. Research Article Relationship of Serum Zinc Level and Macro/Micronutrients with CD4 Levels in HIV Patients Ali Sadeqpour 1 , Hassan Joulaei 2 , Parisa Keshani 3, * and Bahare Izadi 1 1 Department of Public and Community Medicine, Shiraz Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran 2 Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran 3 Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran * Corresponding author: Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran. Email: parisa.keshani@gmail.com Received 2022 April 25; Revised 2022 September 03; Accepted 2022 November 13. Abstract Background: Deficiencies of micronutrients increase the risk of various infections in HIV-infected patients. Zinc deficiency in HIV- infected patients may be associated with decreased CD4 cell counts. Objectives: In this regard, the present study investigated the association between serum zinc levels, macro/micronutrient intake, and CD4 counts in HIV patients. Methods: The research population of this study included 194 adult HIV patients aged 18 to 70 years referred to Shiraz Behavioral Diseases Center, Shiraz, Iran. The CD4 cell counts were extracted from patients’ records. Serum zinc level was measured using atomic absorption method. Univariate and multivariate comparison of macro/micronutrient and food items with CD4 cells was performed using linear regression and SPSS20, and P < 0.05 was considered statistically significant. Results: Fifty-seven percent were male, and the mean age and SD of total participants was 43.76 ± 9.06 years. The association be- tween serum zinc levels and CD4 serum count is close to the significance level (P = 0.05), but the dietary zinc intake was not signifi- cantly correlated with serum CD4 counts (P = 0.26). Vegetable intake (P < 0.001) and fruits (P = 0.01) as well as absorption of vitamin A (P = 0.002), vitamin C (P < 0.001), beta-carotene (P = 0.002), folate (P = 0.05), and fiber (P = 0.01) from diet showed a direct and significant association with serum CD4 levels in HIV patients. Consumption of hydrogenated oils (P = 0.04) showed a significant inverse association with serum CD4 levels in these patients. Conclusions: Evaluation of serum micro/macronutrients can play an essential role in the development of appropriate dietary and supplement guidelines provided by the healthcare system for HIV-infected patients, and it can influence the decision- and policy- making regarding the control of non-pharmacological management of these patients. Keywords: Zinc, Macronutrient, Micronutrient, CD4, HIV 1. Background The human immunodeficiency virus (HIV) is a retro- virus that infects cells with the CD4 marker and often causes immune system dysfunction within several years. The deficiency of the immune system is characterized by a decrease in CD4 + lymphocyte levels. Although currently, HIV patients have a longer lifespan than in the past, the disease can predispose patients to other disorders. Nutri- tional therapy is among clinical care procedures for HIV patients. Developing and maintaining proper nutritional patterns can improve the function of the immune system in many cases. The enhancement of nutritional outcomes is possible by several means, including drug therapies to stimulate appetite and the use of supplements, and even the treatment of comorbid infections in these individuals. Proper nutrition has always been a challenge for these pa- tients, especially those undergoing highly active antiretro- viral therapy (HAART) therapy, and it often affects their morbidity and mortality. Weight loss, anorexia, nutrient malabsorption, diarrhea, and increased metabolism po- tentiate the risk of mortality in these patients (1). Many HIV-specific medications can cause nausea and diarrhea, which in turn leads to the loss of micronutrients. Pa- tients with metabolic and nutritional disorders are prone to other inflammations, which, along with other immune reactions, affect nutritional status even more. Although it is not clear what deficiency in the diet increases a person’s susceptibility to HIV infection, it is accepted that the pro- gression of AIDS or improved response to antiviral drugs depends on a person’s nutritional status. The deficiency of several micronutrients, known as “hidden hunger”, which Copyright © 2022, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.