TreatmentUpdate79 - Vol. 7, No. 9; July 1997
Sean Hosein

Tylenol is a popular pain reliever because it works for many people. However, for people with damaged livers or kidneys, Tylenol may not be safe. Since people with HIV/AIDS may already have livers burdened by the use of various medications, attacks by viruses that cause liver damage and alcohol use, adding Tylenol may increase liver damage. Indeed, one recent study from Spain suggests that PHAs may not be able to detoxify Tylenol as well as other people. Indirectly, use of Tylenol may cause additional damage to the immune system.

Study Details

Researchers recruited 9 symptom-free people with HIV (1 female, 8 males) who had an average of 515 CD4+ cells, 19 people with AIDS (6 female, 13 male) whose average CD4+ count was 94 cells and another group of 32 healthy, non-HIV-infected volunteers (subjects). All subjects received a single dose of 1.5 grams of Tylenol between 8 and 9 am. Urine samples were collected over the following 24 hours.

Results

By analysing urine samples, researchers found that people with AIDS were, on average, less able to detoxify Tylenol compared to other subjects. This difference was statistically significant; that is, not likely due to luck or chance.

The likely reason for the reduced ability of people with AIDS to detoxify Tylenol is that their livers don't contain enough GSH (glutathione). Liver and other cells use GSH to protect themselves from harmful chemical reactions. Several studies have found less than normal levels of GSH in people with decreasing CD4+ cell counts, and at least one study has linked declining CD4+ cell counts to decreasing GSH levels. Other studies have suggested PHAs may not be able to make enough GSH to meet their needs. So substances that use up the body's supply of GSH may contribute to the decline of the immune system.

How to get more GSH

The body makes GSH using the amino acid cysteine, which is found in eggs, dairy products and supplements such as Immunocal«. Another more direct way of obtaining cysteine is to take supplements of NAC (N-acetyl-cysteine), which is licensed in North America for the treatment of Tylenol poisoning and is available from some buyers clubs and health food stores. Nutritional guidelines for PHAs produced by Lark Lands and Chester Myers and others, are available from CATIE.

REFERENCES:

1. Esteban A. Perez-Mateo M, Boix V, et al. Abnormalities in the metabolism of acetaminophen in patients infected Human Immunodeficiency Virus (HIV). Methods and Findings in Experimental and Clinical Pharmacology 1997;19(2):129-132.

2. Herzenberg LA, De Rosa SC, Dubs JG, et al. Glutathione deficiency is associated with impaired survival in HIV disease. Proceedings of the National Academy of Sciences USA 1997;94(5):1967-1972.

3. Blair PJ, Boise LH, Perfetto SP, et al. Impaired induction of the apoptosis-protective protein Bcl-xl in activated PBMC from asymptomatic HIV-infected individuals. Journal of Clinical Immunology 1997;17(3):234-246.

4. Watson WG, Rotstein OD, Jimenez M, et al. Augmented intracellular glutathione inhibits Fas-triggered apoptosis of activated human neutrophils. Blood 1997;89(11):4175-4181.

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Copyright © 1997 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca