TreatmentUpdate77 - Vol. 7, No. 7; April 1997
Sean Hosein

Study Details

The study consisted of 3 parts:

* a large observational study

* an 8 week placebo-controlled study of NAC

* a 6 month study of NAC use.

Doctors enrolled 204 males, half of whom had less than 201 CD4+ cells and compared them to 79 healthy, non-HIV-infected subjects. Some of the HIV-infected subjects later entered the 8 week and 6 month NAC studies.

Results -- large observational study

Technicians measured the amount of GSH in the CD4+ cells of subjects and found that, in general, HIV-infected subjects had less GSH than non-HIV-infected subjects. Among the HIV-infected subjects, researchers found that 50% of those with 200 or more CD4+ cells and 70% of those with less than 200 CD4+ cells had lower than normal levels of GSH.

Results -- 8 week placebo study

The doctors assigned 53 HIV-infected subjects to receive either NAC (most took 4.4 grams/day) or fake NAC (placebo) for 8 weeks. Subjects receiving NAC had their level of GSH in the blood rise. Although the resulting levels of NAC in the blood did not rise to normal, the increase was still statistically significant; that is, not likely due to chance alone. Side effects reported were rash and nausea.

Results -- 6 month study

At the end of the 8 week sub-study, researchers offered all subjects who were in that sub-study the option of taking NAC for 6 months and found that:

* 13 who received NAC and

* 12 who received placebo

agreed to enter the 6 month study.

The researchers found that:

* subjects who had less than 200 CD4+ cells and who took NAC for between 8 to 32 weeks survived "significantly longer" than similar subjects who did not receive NAC, and,

* in general, subjects who took NAC were "roughly twice as likely to survive for 2 years [longer than] subjects who did not take NAC."

These differences between subjects who took NAC and others who did not were statistically significant. Survival over the 2-3 years of the study was not affected by use of AZT or related drugs.

What to do?

The results of this study suggests that as GSH levels fall, PHAs are at increased risk of death. To make GSH the body needs the amino acid cysteine. Good sources of cysteine include eggs and dairy products. Given the problems with malabsorption and appetite that occur in HIV/AIDS, supplements of NAC should be considered. NAC is safe and has been used as a treatment for Tylenol« poisoning for decades. Several nutritional protocols suggest a daily dose of around 1,500 mg/day. Taking NAC with other antioxidants such as vitamins C and E should help reduce the body's demand for GSH. The researchers conducting the study encourage PHAs to avoid the use of chemicals that reduce levels of GSH such as alcohol and Tylenol« (acetaminophen). Nutritional protocols designed for PHAs by Lark Lands, Chester Myers and others are available from CATIE.

REFERENCES:

1. 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.

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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